Accountability and disclosure commission



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NEBRASKA

ACCOUNTABILITY AND

DISCLOSURE COMMISSION

11th Floor, State Capitol

P.O. Box 95086

Lincoln, NE 68509

(402) 471-2522
BEFORE COMPLETING THIS FORM READ THE FILING REQUIREMENTS ON PAGE 3





POSTMARK

DATE
MICROFILM

NUMBER


EMPLOYMENT OF IMMEDIATE FAMILY MEMBERS DISCLOSURE STATEMENT
NADC FORM C-4

OFFICE USE ONLY


















  • Public officials and employees employing, recommending employment, or supervising the employment of an immediate family member must disclose the employment either in writing or on the record to the governing body employing the immediate family member.

  • File this form or other written disclosure with the person in charge of keeping records for the governing body employing the immediate family member.

  • Person who fail to disclose the employment of immediate family members or who otherwise do not comply with the law are subject to penalties.

ITEM 1

NAME, ADDRESS AND TELEPHONE NUMBER OF PUBLIC OFFICIAL OR PUBLIC EMPLOYEE













Name

     

     

     

Telephone No.

     




Last

First

Middle







Address

     

     




     




     




STREET ADDRESS OR RURAL ROUTE

City




STATE

ZIP CODE

ITEM 2

OFFICE OR POSITION, ADDRESS, TELEPHONE, TERM OF OFFICE













Office or Position:

     

Term:

     










Identify City, County, District, or State Agency:

     













Address:

     

Telephone

     































ITEM 3

MEMBER OF YOUR IMMEDIATE FAMILY WHOM YOU INTEND TO EMPLOY, RECOMMEND FOR EMPLOYMENT, OR SUPERVISE (Use ITEM 5 CONTINUATION, if necessary)













A. Name

     

Relationship

     













Position

     

Employer

     







(IDENTIFY CITY, COUNTY, DISTRICT OR STATE AGENCY)

B. Name

     

Relationship

     




Position

     

Employer

     




(IDENTIFY CITY, COUNTY, DISTRICT OR STATE AGENCY)

C. Name

     

Relationship

     




Position

     

Employer

     




(IDENTIFY CITY, COUNTY, DISTRICT OR STATE AGENCY)










ITEM 4

FOR NEWLY ELECTED OR APPOINTED PUBLIC OFFICIALS AND EMPLOYEES







List members of your immediate family who were employed before your election or appointment, or prior to July 17, 1986 and are now employed or supervised by you.







A. Name

     

Relationship

     







Position

     

Employer

     




(IDENTIFY CITY, COUNTY, DISTRICT OR STATE AGENCY)

Date Hired

     










B. Name

     

Relationship

     













Position

     

Employer

     







(IDENTIFY CITY, COUNTY, DISTRICT OR STATE AGENCY)

Date Hired

     






(Use ITEM 5, CONTINUATION, if necessary)



ITEM 5

CONTINUATION

     







     

(Signature)




(Date)

General Information - Filing Requirements


A public official or public employee may employ, recommend the employment of, or supervise the employment of an immediate family member if:


  1. he or she does not abuse his or her official position; and

  2. makes a written disclosure with the person in charge of keeping records for the governing body or a disclosure on the record to the governing body; and

  3. he or she has first made a reasonable solicitation and consideration of applications for such employment:

NOTE: Examples of abuse of one's position could include, but are not limited to, (1) providing an unreasonably high salary, (2) not requiring the employee to actually perform the duties of his or her position, (3) terminating another employee to make a position available for an immediate family member, (4) hiring an immediate family member who is not qualified to hold the position.




  1. Who Must File:




  1. Public officials and employees employing, recommending employment, or supervising the employment of an immediate family member must make a disclosure to the person in charge of keeping records for the governing body of the entity. Where applicable the disclosure may be made on the record to the governing body of the entity in lieu of a written disclosure.




  1. Public officials and employees who currently employ or supervise an immediate family member(s) employed prior to the election or appointment of the public official or public employee or prior to July 17, 1986.




  1. When to File:




  1. Public officials and employees must file prior to employing, recommending employment, or supervising the employment of an immediate family member.

  2. Newly elected or appointed public officials or employees shall file prior to or as soon as reasonably possible after the official date of taking office.



  1. Where to File:

This form or other written disclosure should be filed with the person in charge of keeping records for the governing body of the entity served. (i.e., state officials and employees file with the head of their agency or department; officials and employees of public power districts file with the district office; county officials and employees file with the county clerk; city of village officials or employees file with the city or village clerk; officials and employees of natural resource districts file with the office of the district manager; school district officials and employees file with the district superintendent or secretary of the school board. Disclosure need not be made to the Nebraska Accountability and Disclosure Commission.


Disclosure of Contractual Interests by Local Officers. If you are disclosing an interest in a contract to which a local governing body on which you serve is a party, use NADC Form C-3, Contractual Interest Statement.
Disclosure of Potential Conflict of Interest by State Executive Branch Officials, Employees, and Others Required to file Statements of Financial Interests. If you are disclosing a potential conflict of interest under section 49-1499 of the Accountability Act, use NADC Form C-2, Potential Conflict of Interest Statement.



Definitions


Governing body means the village board of a village, the city council of a city, the board of commissioners or board of supervisors of a county, the board of directors of a public power district, or any body with the ultimate power to determine the entity's policies and control its activities.
Immediate Family Member means a child residing in an individual's household, a spouse of an individual, or an individual claimed by the public official or employee or his or her spouse as a dependent for federal income tax purposes.
Public employee means an employee of the state or a political subdivision thereof.
Public official shall mean an official in the executive branch, an official in the legislative branch, or an elected or appointed official in the judicial branch of the state government or a political subdivision thereof; any elected or appointed members of a governing body of a state institution of high education.

Official in the executive branch means an official holding a state executive office as provided in Article IV, Constitution of Nebraska, including Governor, Lieutenant Governor, Secretary of State, Auditor of Public Accounts, State Treasurer, Attorney General, Tax Commissioner, the heads of such other executive departments as set forth in the Constitution or as may be established by law, a deputy thereto, or a member of any state board or commission.
Official in the legislative branch means a member or member-elect of the Legislature, a member of an official body established by and responsible to the Legislature, or employee thereof other than an individual employed by the state in a clerical or nonpolicymaking capacity.
Statutory Authority: Section 49-1499.01 Revised Statutes of Nebraska.


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