HomeMy WebLinkAboutFORM-DISCLOSURE-of-FAMILY-MEMBER-with-APPLICATIONS-FOR-EMPLOYMENT-003
DISCLOSURE of FAMILY MEMBER on APPLICATIONS FOR EMPLOYMENT
(Employment of Relatives, Policy Number )
Bergen Community College employees and potential employees must complete this form and
obtain approval if their Family Member applies for employment by Bergen Community College.
Applicant Name: BCC Title:
Projected Start Date: Contact Phone:
BCC Department or Office:
Family Member Name: BCC Title:
Hire or Projected Start Date: Contact Phone:
BCC Department or Office: Relationship to Employee:
Supervisor’s Name & Title: Work Phone:
Would the BCC employee directly supervise a family member’s position? Yes ____ No ___
Would the BCC employee have authority over a unit in which a family member works? Yes _ No __
Describe the reporting line between your Family Member’s position and your position:
Describe any involvement you have had in obtaining authorization for, describing, recruiting or supervising
the Family Member’s position:
I hereby certify that to the best of my knowledge the above is a true, correct and complete statement. I
acknowledge receipt of the notice below.
Date Signature of Disclosing Party
Employee must forward to BCC’s Department of Human Resources for review by the Vice President
of Human Resources and Organizational Effectiveness. Final approval will be determined by the BCC
President.
________________________________
Reviewed by VP of Human Resources Date: ____________
Forwarded to General Counsel? ___ Yes ___ No Date: ____________
(HR must forward to General Counsel those forms where the employee’s position either directly supervises
or has authority over the unit in which the family member works.)
Notice: Thank you for your disclosure. Family member employment is not prohibited by BCC Policy. However, BCC
Policy restricts Family Member employment where an employee’s position has authority to take official action affecting
the family member’s employment. Employment may still be possible if authority may be removed and re-delegated.
“Family Member” is defined in BCC Policy No. . Other provisions of the Nepotism Policy may apply,
including granting unwarranted benefits or treatment, and taking or withholding official action in order to affect a matter
in which the employee or the employee’s family member has a personal or financial interest. Contact the BCC
Department of Human Resource.