On this page you will find the following forms:

  • Conflict of Interest Disclosure Form
  • Change of Contact Information Form
  • Emergency Contact Form

Conflict of Interest Disclosure Form

PURPOSE: Rodgers Security Solutions Inc. (RSS) is committed to maintaining the highest standards of integrity and transparency. This Conflict of Interest Disclosure Form is designed to identify and mitigate any conflicts of interest that may arise in the course of our business operations.
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Instructions:

All employees, contractors, and affiliates of RSS are required to complete this form annually and whenever a potential conflict of interest arises. Please provide complete and accurate information to the best of your knowledge. If you have any questions or need assistance in completing this form, please email the HR Department or contact them by phone.

Personal Information

 

Name

Disclosure Questions

 

Outside Employment/Business Interests: Do you have any outside employment, business interests, or affiliations that could potentially conflict with your duties at RSS?
Financial Interests: Do you or any immediate family members have a financial interest (e.g., ownership, investment, partnership) in any entity that does business with RSS?
Personal Relationships: Do you have any personal relationships (e.g., family, friends) with individuals who are employed by or have a business relationship with RSS?
Gifts and Hospitality: Have you received any gifts, hospitality, or other benefits from individuals or organizations that do business with RSS?
Other Potential Conflicts: Are you aware of any other situations or activities that could create a conflict of interest or the appearance of a conflict of interest?

Certification

 

I certify that the information provided in this disclosure form is true and complete to the best of my knowledge. I understand that any misrepresentation or omission may be grounds for disciplinary action, up to and including termination of employment or contract.
A copy of this disclosure will also be emailed to you.

Contact Information Change Form

Complete this form to have your address or other contact information changed. This is important as our system will issue all tax, payroll, and other documentation to the address we have on file. To ensure you receive paperwork in a timely manner, please complete this form.
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Name
Contractors Only
Which of these are you updating [check all that apply]

Emergency Contact Form

Complete this form to provide us with your emergency contacts information.
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Your Name
Your Email
Your Address

Emergency Contact # 1 Information

Your primary contact
Name
Is their address different than yours?
Would you like us to share relevant medical information with this person in case of a medical emergency?

Emergency Contact # 2 Information

Name
Do they live at the same address as you?
Would you like us to share relevant medical information with this person in case of a medical emergency?

Voluntary Disclosure of Emergency Medical Information

If you would like to disclose any medical information that would help us respond to a medical emergency, such as food allergies, please use the space below to share.
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