Wmd Form 2004 12 PDF Details

In an era where operational transparency and conflict of interest mitigation are paramount, the WMD Form 2004-12 serves as a crucial document for members of the Military Department seeking to engage in outside employment. This comprehensive form mandates the disclosure of detailed employee information, including but not limited to name, personnel number, division, unit, job classification, and contact details. Furthermore, it requires the submission of extensive details pertaining to the proposed outside employment, including the employer's name, business and occupation number, Tax ID, job title, supervisor information, and a thorough description of job duties. Perhaps most critically, the form contains a set of pivotal questions aimed at identifying potential conflicts of interest, probing into whether the outside employment intersects with the employee's duties at the Military Department, or involves a business or entity that could influence or conduct operations regulated by the department. Approval process details are meticulously outlined, including steps for supervisor, manager, EMT Director, HR Director, and possibly Director (TAG) review, highlighting the layered oversight mechanism adopted by the department. Employees are reminded of the necessity of honesty and completeness in their disclosure, underlining the form's role in maintaining the integrity of both the individual's and the department's professional responsibilities. By incorporating such exhaustive details and procedural steps, the WMD Form 2004-12 embodies the department's commitment to ethical conduct and the avoidance of conflicts of interest in its workforce's engagements beyond their primary employment.

QuestionAnswer
Form NameWmd Form 2004 12
Form Length2 pages
Fillable?No
Fillable fields0
Avg. time to fill out30 sec
Other namessample of usa military form, military registration form, soldiers forms, what to do when applying military forms

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MILITARY DEPARTMENT

DISCLOSURE/REQUEST FOR OUTSIDE EMPLOYMENT FORM

 

 

EMPLOYEE INFORMATION

Name (Last, First, MI)

 

 

Personnel Number

 

 

 

 

Division

Unit

 

Job Classification

 

 

 

 

Work Phone Number:

 

 

Work Email Address

 

 

 

 

INFORMATION REGARDING OUTSIDE EMPLOYMENT

Name of Outside Employer or Organization

Business & Occupation #:

Tax ID #

 

 

Address of Outside Employer:

Location of Outside Employment (if different from

 

mailing address):

 

 

Job Title

Business e-mail address:

 

 

Name of Immediate Supervisor

Supervisor Contact Information (phone and e-mail)

 

 

Describe the Outside Employer’s business:

Describe the specific job duties you will perform for this outside employer, or attach a current position description (preferred):

Average weekly paid or volunteer hours worked

Average weekly paid or volunteer hours worked

 

 

Please check YES or NO for the questions. If you answer YES” to any of the above questions, please explain your affirmative response(s) either on this form, or attach a separate signed statement explaining your response.

Yes

No

Is this outside employer a client or customer of WMD and/or any of its divisions?

 

 

 

Yes

No

Does this outside employer do business with, or try to influence, WMD or other

 

 

state government policies (i.e. lobbying)?

 

 

 

Yes

No

Would this outside employment involve paid activities which are normally a part of

 

 

your WMD duties?

 

 

 

Yes

No

Do you know of any other factors which could create an actual, or perceived by

 

 

others, conflict of interest with your state employment?

 

 

 

WMD FORM 2004-12

Yes

No

Does this outside employer conduct operations, or activities, which are regulated

 

 

by WMD?

 

 

 

Explanation for areas in which you marked yes on the previous page (attach additional pieces of paper if necessary).

By my signature, I certify that this information is true and complete to the best of my knowledge. I also certify that I I have read and understand Washington Military Department Policy #HR-241-02 pertaining to WMD State Employees engaging in Outside Employment. Further, I understand this outside employment report will be placed in both my personnel and payroll files.

 

 

 

 

 

 

 

 

 

 

 

 

NAME:

 

 

 

DATE:

 

 

 

 

 

 

 

 

APPROVAL PROCESS

 

 

 

 

Office / Function

 

 

Recommendation

 

Signature

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

Supervisor

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

 

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Manager

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

APPROVAL

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

EMT Director

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Approval

 

 

 

 

 

 

 

HR Director

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Director (TAG) Review

 

 

Approval

 

 

 

 

 

 

 

(if required)

 

 

Approved with noted conditions

 

 

 

 

 

 

 

 

 

 

Disapproval

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Comments:

 

 

 

 

 

 

 

 

 

cc:Payroll file Personnel file

WMD FORM 2004-12

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