Get the free Moonlighting Statement 053113 - University of Rochester

Moonlighting Statement Please indicate below whether you have moonlighted. If you have not, please check the first box. If you have, please complete the section to provide us with the hospitals and

How to fill out moonlighting statement 053113

How to fill out moonlighting statement 053113:

1. Obtain the moonlighting statement form: The moonlighting statement form, also known as the 053113 form, can usually be obtained from your employer. It may be provided to you during the hiring process or at a later stage if the need arises for you to disclose any potential conflicts of interest due to additional employment.
2. Review the form instructions: It is important to carefully read and understand the instructions provided on the moonlighting statement form. These instructions will guide you on how to accurately and comprehensively fill out the form.
3. Provide personal information: Start by providing your personal information such as your full name, contact details, and employee identification number (if applicable). Make sure to double-check the accuracy of this information to avoid any discrepancies.
4. State current employment details: Fill in the details of your primary employment, including the company name, your job title, and your supervisor's name. This information helps establish your primary work arrangement.
5. Declare secondary employment details: If you have any secondary employment or engage in any freelance work, disclose the necessary details. This typically includes the name of the organization or individual you work for, your job title or position, your estimated hours worked per week, and any other relevant information requested on the form.
6. Describe any potential conflicts of interest: In this section, you may be required to disclose any potential conflicts of interest that may arise from your secondary employment. Be honest and thorough in providing this information, as it helps your employer evaluate and address any potential conflicts or concerns.
7. Obtain necessary signatures: Once you have completed filling out the moonlighting statement form, review it for accuracy and ensure that you have answered all the required questions. Then, sign and date the form as instructed. In some cases, you may also be required to obtain your supervisor's or manager's signature as an acknowledgment.

Who needs moonlighting statement 053113?

1. Employees with multiple jobs: If you hold multiple jobs concurrently or engage in secondary employment while working for a company, you may be required to fill out a moonlighting statement form. This ensures transparency and allows employers to evaluate any potential conflicts of interest that may arise from such arrangements.
2. Freelancers or contractors: Individuals who work as freelancers or contractors, providing services to different organizations or individuals, may also be required to submit a moonlighting statement form. This is done to ensure that any conflicts of interest are properly addressed and managed.
3. Certain industries or professions: Depending on the industry or profession, some employers may have specific policies or regulations in place that necessitate the completion of a moonlighting statement form. This is particularly common in fields such as healthcare, finance, and government, where potential conflicts of interest can have significant implications.

Overall, filling out a moonlighting statement 053113 is an essential step to ensure transparency and effectively manage potential conflicts of interest that can arise from secondary employment arrangements.

For pdfFiller’s FAQs

What is moonlighting statement 053113?

The moonlighting statement 053113 is a form used by individuals to disclose any outside employment or activities they engage in addition to their primary job.

Who is required to file moonlighting statement 053113?

All employees who have outside employment or activities in addition to their primary job are required to file the moonlighting statement 053113.

How to fill out moonlighting statement 053113?

The moonlighting statement 053113 can be filled out by providing details of the outside employment or activities, including the nature of the work, hours spent, and any potential conflicts of interest.

What is the purpose of moonlighting statement 053113?

The purpose of the moonlighting statement 053113 is to ensure transparency and prevent conflicts of interest that may arise from outside employment or activities.

What information must be reported on moonlighting statement 053113?

The moonlighting statement 053113 requires individuals to report details of the outside employment or activities, including the nature of the work, hours spent, and any potential conflicts of interest.

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