Conflict of Interest form

Instructions

  • Please read this form with reference to the NRC Policy on Conflict of Interest and Post-Employment (2015) both as someone joining NRC and as part of a regular review.
  • Check the corresponding box(es) when you determine that a real, apparent or potential conflict of interest situation could exist between your official duties and other interests.
  • For any checked item, please provide details and describe the nature of the matter in the space provided. You can also print out the form and send to the NRC Secretary General's Office (NRC-SGO)
  • You are NOT REQUIRED to submit this form if after reviewing it and the NRC Policy on Conflict of Interest and Post-Employment (2015) you determine that you have nothing to declare. However, all new and potential NRC-IRAP employees are to submit a conflict of interest form.
  • The Conflict of Interest and Post-Employment Declaration Form is intended to facilitate communication between you, your management and the NRC Secretary General's Office (NRC-SGO). Declarations submitted to the NRC-SGO are assessed to confirm whether or not the situation constitutes a real, apparent or potential conflict between your personal interests and your official duties and/or responsibilities within NRC. If such a conflict is found to exist, a plan is developed to resolve the situation. Early involvement of your management in discussions can assist in the assessment and resolution of the situation.
  • Non-salaried workers: You are to comply with the intent of the NRC Policy on Conflict of Interest and Post-Employment (2015), and any related conditions indicated in your agreement with NRC, but you are not required to submit this form to the NRC-SGO.

Protected when completed.

Contact information

Status

Status

Assets and Liabilities

Do you possess, or are you considering acquiring, any relevant (with respect to the NRC COI Policy)

Do you possess, or are you considering acquiring, any relevant (with respect to the NRC COI Policy)

Description of the situation regarding assets and liabilities

Outside employment or activities

Do you participate or are you considering participating in any of the following?

Do you participate or are you considering participating in any of the following?

Description of the situation regarding outside employment or activities

Benefits

Benefits

Description of the situation regarding benefits

Relationships

Relationships

Description of the situation regarding relationships

Post-Employment (designated categories only)

Post-Employment (designated categories only)

Other

Other

Description of the situation regarding other instances

Declaration – Privacy Act Statement

The information you provide on this document is collected under the authority of the National Research Council Act and NRC's authority as a separate employer under the Financial Administration Act, for the purpose of maintaining information about real or potential conflict of interest situations. It will be stored in personal information bank number NRC/P-PE-801. Personal information that you provide is protected under the provisions of the Privacy Act, and you may review it for accuracy in accordance with the provisions of this law.


The information is sent securely over SSL

For additional information, please consult the NRC policy on Conflict of Interest and Post-Employment (COI) and post-employment

You should promptly submit a revised declaration whenever there is a relevant change in your personal situation or your official responsibilities.