HomeContact Forms Go Back 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. Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.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 *FirstLastPosition/Title/Role with RSS *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?YesNoIf "Yes" please explainFinancial 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? *YesNoIf "Yes" please explainPersonal Relationships: Do you have any personal relationships (e.g., family, friends) with individuals who are employed by or have a business relationship with RSS? *YesNoIf "Yes" please explainGifts and Hospitality: Have you received any gifts, hospitality, or other benefits from individuals or organizations that do business with RSS? *YesNoIf "Yes" please explainOther 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? *YesNoIf "Yes" please explainCertification 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. *YesYour Email *A copy of this disclosure will also be emailed to you.Today's Date *Submit 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.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Name *FirstLastCompany NameContractors OnlyEmail *Which of these are you updating [check all that apply]New emailName changeNew phone numberNew physical addressNew mailing addressNew website [contractors only]New company name [contractors only]New Legal NameFirstLastNew EmailIf different that the email address you typed aboveNew Company NameContractors OnlyWebsite / URLContractors OnlyPhone NumberPhysical AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeMailing AddressAddress Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeComments or Additional InformationSubmit Emergency Contact Form Complete this form to provide us with your emergency contacts information.Please enable JavaScript in your browser to complete this form.Please enable JavaScript in your browser to complete this form.Your Name *FirstLastYour Role/Position/Relationship with RSS *Your Email *EmailConfirm EmailYour Phone *United States +1United States+1United Kingdom+44Afghanistan+93Albania+355Algeria+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua & Barbuda+1Argentina+54Armenia+374Aruba+297Ascension Island+247Australia+61Austria+43Azerbaijan+994Bahamas+1Bahrain+973Bangladesh+880Barbados+1Belarus+375Belgium+32Belize+501Benin+229Bermuda+1Bhutan+975Bolivia+591Bosnia & Herzegovina+387Botswana+267Brazil+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria+359Burkina Faso+226Burundi+257Cambodia+855Cameroon+237Canada+1Cape Verde+238Caribbean Netherlands+599Cayman Islands+1Central African Republic+236Chad+235Chile+56China+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros+269Congo - 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Brazzaville+242Congo - Kinshasa+243Cook Islands+682Costa Rica+506Croatia+385Cuba+53Curaçao+599Cyprus+357Czech Republic+420Côte d’Ivoire+225Denmark+45Djibouti+253Dominica+1Dominican Republic+1Ecuador+593Egypt+20El Salvador+503Equatorial Guinea+240Eritrea+291Estonia+372Eswatini+268Ethiopia+251Falkland Islands+500Faroe Islands+298Fiji+679Finland+358France+33French Guiana+594French Polynesia+689Gabon+241Gambia+220Georgia+995Germany+49Ghana+233Gibraltar+350Greece+30Greenland+299Grenada+1Guadeloupe+590Guam+1Guatemala+502Guernsey+44Guinea+224Guinea-Bissau+245Guyana+592Haiti+509Honduras+504Hong Kong+852Hungary+36Iceland+354India+91Indonesia+62Iran+98Iraq+964Ireland+353Isle of Man+44Israel+972Italy+39Jamaica+1Japan+81Jersey+44Jordan+962Kazakhstan+7Kenya+254Kiribati+686Kosovo+383Kuwait+965Kyrgyzstan+996Laos+856Latvia+371Lebanon+961Lesotho+266Liberia+231Libya+218Liechtenstein+423Lithuania+370Luxembourg+352Macau+853Madagascar+261Malawi+265Malaysia+60Maldives+960Mali+223Malta+356Marshall Islands+692Martinique+596Mauritania+222Mauritius+230Mayotte+262Mexico+52Micronesia+691Moldova+373Monaco+377Mongolia+976Montenegro+382Montserrat+1Morocco+212Mozambique+258Myanmar (Burma)+95Namibia+264Nauru+674Nepal+977Netherlands+31New Caledonia+687New Zealand+64Nicaragua+505Niger+227Nigeria+234Niue+683Norfolk Island+672North Korea+850North Macedonia+389Northern Mariana Islands+1Norway+47Oman+968Pakistan+92Palau+680Palestine+970Panama+507Papua New Guinea+675Paraguay+595Peru+51Philippines+63Poland+48Portugal+351Puerto Rico+1Qatar+974Romania+40Russia+7Rwanda+250Réunion+262Samoa+685San Marino+378Saudi Arabia+966Senegal+221Serbia+381Seychelles+248Sierra Leone+232Singapore+65Sint Maarten+1Slovakia+421Slovenia+386Solomon Islands+677Somalia+252South Africa+27South Korea+82South Sudan+211Spain+34Sri Lanka+94St Barthélemy+590St Helena+290St Kitts & Nevis+1St Lucia+1St Martin+590St Pierre & Miquelon+508St Vincent & Grenadines+1Sudan+249Suriname+597Svalbard & Jan Mayen+47Sweden+46Switzerland+41Syria+963São Tomé & Príncipe+239Taiwan+886Tajikistan+992Tanzania+255Thailand+66Timor-Leste+670Togo+228Tokelau+690Tonga+676Trinidad & Tobago+1Tunisia+216Turkey+90Turkmenistan+993Turks & Caicos Islands+1Tuvalu+688US Virgin Islands+1Uganda+256Ukraine+380United Arab Emirates+971United Kingdom+44United States+1Uruguay+598Uzbekistan+998Vanuatu+678Vatican City+39Venezuela+58Vietnam+84Wallis & Futuna+681Western Sahara+212Yemen+967Zambia+260Zimbabwe+263Åland Islands+358Email *Is their address different than yours? *No, we live at the same addressYes, they live at a different addressAddress #1 (if different than yours)Address Line 1Address Line 2City— Select state —AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingStateZip CodeWould you like us to share relevant medical information with this person in case of a medical emergency? *YesNoEmergency Contact # 2 Information Name *FirstLastRelationship to You *SpousePartner/Significant OtherParentSiblingOther RelativeFriend/AssociateHome/Mobile Phone *United States +1United States+1United Kingdom+44Afghanistan+93Albania+355Algeria+213American Samoa+1Andorra+376Angola+244Anguilla+1Antigua & Barbuda+1Argentina+54Armenia+374Aruba+297Ascension Island+247Australia+61Austria+43Azerbaijan+994Bahamas+1Bahrain+973Bangladesh+880Barbados+1Belarus+375Belgium+32Belize+501Benin+229Bermuda+1Bhutan+975Bolivia+591Bosnia & Herzegovina+387Botswana+267Brazil+55British Indian Ocean Territory+246British Virgin Islands+1Brunei+673Bulgaria+359Burkina Faso+226Burundi+257Cambodia+855Cameroon+237Canada+1Cape Verde+238Caribbean Netherlands+599Cayman Islands+1Central African Republic+236Chad+235Chile+56China+86Christmas Island+61Cocos (Keeling) Islands+61Colombia+57Comoros+269Congo - 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