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Secondary Employment Disclosure

  1. In order to avoid situations that might affect an employee's performance, cause a conflict of interest or reflect negatively on the town's integrity and reputation, employees are required to disclose any other employment they may have accepted or intend to accept, including self-employment.

    It is the employee's responsibility to maintain current employment information with the town. Failure to disclose secondary employment may be the basis for disciplinary action.
  2. Self-Employed?*
  3. To the best of your knowledge, does this employer supply any goods or services directly to the Town of Hillsborough?*
  4. To the best of your knowledge, in the course of your employment will you be working at residences in the Town of Hillsborough?*
  5. Acknowledgement*
    I hereby waive my right to use any sick, vacation or holiday leave while absent from work as a result of any injury, disability or illness that arises out of or in the course of outside employment.

    I further understand that I am not eligible for workers' compensation or sick leave benefits from the town for injuries arising out of or in the course of outside employment. I also understand that I must notify my department head if I change employers or work hours.
  6. Leave This Blank:

  7. This field is not part of the form submission.