Financial Conflict of Interest and Disclosure
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Employee Name:
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The above mentioned employee hereby certifies that they have no affiliation with or financial involvement in any entity that has direct financial interest in the business relationships of ACME Publishing except as disclosed in an attachment. Please check the appropriate box of this form.
Do you have any conflict of interest or financial involvement with ACME Publishing?
[__] No
[__] Yes, explanation attached
_______________________ Date_____
Signature
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Print Name
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