Form Center • Clinton Township, MI • CivicEngage

Relative Disclosure Statement for Public Officials

In accordance with the Charter Township of Clinton Ethics Policy, public officials must disclose existing relatives employed by the Township and/or relatives who apply for employment prior to the hiring process. Questions should be directed to the Human Resources Department, 40700 Romeo Plank Rd., Clinton Township, MI 48038, Telephone 586-286-9341.
FORM MUST BE FILED WITH THE HUMAN RESOURCES DEPARTMENT BY THE PUBLIC OFFICIAL WITHIN 5 DAYS OF RELATIVE'S APPLICATION FOR EMPLOYMENT WITH THE TOWNSHIP
Date of Statement
Date of Statement
OFFICIAL'S INFORMATION
First Name
Last Name
Street Address
City
State
Zip
Township Position
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PART A - CURRENT EMPLOYEES
Identify any current relative holding a full and/or part-time position with the Charter Township of Clinton. For the purpose of this disclosure, a relative is defined as any of the following, whether by blood or adoption: parent, child, brother, sister, aunt, uncle, niece, nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half-brother, or half-sister.
Employee Name
Title/Position
Department
Relationship to Official
Employee Name
Title/Position
Department
Relationship to Official
Employee Name
Title/Position
Department
Relationship to Official
Employee Name
Title/Position
Department
Relationship to Official
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PART B - PROSPECTIVE EMPLOYEES
Identify any relative applying for a full and/or part-time position with the Charter Township of Clinton. For the purpose of this disclosure, a relative is defined as any of the following, whether by blood or adoption: parent, child, brother, sister, aunt, uncle, niece, nephew, grandparent, grandchild, father-in-law, mother-in-law, son-in-law, daughter-in-law, stepfather, stepmother, stepson, stepdaughter, stepbrother, stepsister, half-brother, or half-sister.
Relative's Name
Title/Position Applying
Relationship
Relative's Name
Title/Position Applying
Relationship
Relative's Name
Title/Position Applying
Relationship
Relative's Name
Title/Position Applying
Relationship
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ATTESTATION
I hereby acknowledge that the information contained herein is to the best of my knowledge correct and complete.
Electronic Signature Agreement
By checking the "I agree" box below, you agree and acknowledge that 1) your application will not be signed in the sense of a traditional paper document, 2) by signing in this alternate manner, you authorize your electronic signature to be valid and binding upon you to the same force and effect as a handwritten signature, and 3) you may still be required to provide a traditional signature at a later date.
1. I agree.
Electronic Signature
Date:
Date:

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