COI Form - Candidate EN - Rev PDF

CONFIDENTIAL
Conflict of Interest Disclosure Form for Candidates

Roll over terms in BLUE to see a definition. References to SNC-Lavalin in this form include all member companies of the SNC-Lavalin Group.
The SNC-Lavalin Code of Ethics and Business Conduct (“Code”) requires that certain disclosures be made in order
to avoid situations of actual, potential or perceived conflict of interest (COI) and ensure compliance with legal
obligations related to the hiring of current and former government officials and their immediate family members.
SNC-Lavalin is committed to treating and resolving, with discretion and confidentiality, any conflict of interest that is
brought to our attention. Please note that disclosing a conflict of interest does not necessarily preclude employment
with SNC-Lavalin.
As a candidate, we ask you to voluntarily disclosure any conflict of interest in order to evaluate if and how it may
affect the role and responsibilities of the position you are applying for. Should you have any questions regarding this
form, please speak with the SNC-Lavalin recruiter.
1. Candidate Information
Last Name:
First Name:
Email:
Telephone Number:
I agree to voluntarily disclose, to the best of my knowledge, all conflicts of interest that apply to my current
situation, as described in section 2 and 3 of this form.
I refuse to voluntarily disclose any conflict of interest, that applies to my current situation. I understand and
agree that, should I become an employee of SNC-Lavalin, I will have to declare any such conflict of interest.
2. Declaration
Where you disclose a COI it will be shared with your hiring manager as part of the COI assessment and sign off process.
Any data collected will be protected and processed in line with our internal policies and our legal and compliance obligations.
2.1 Outside Employment or Activities - Please provide additional information in Section 3.

I am engaged or will be engaging in secondary employment.
I have accepted or will be accepting a directorship or a non-executive position

(does not include school governorships) with a third-party organization.
I have established or will be establishing a business relationship with a competitor, business partner,
supplier or client of SNC-Lavalin.
I own or plan to own a significant financial interest in a competitor, business partner, supplier or
client of SNC-Lavalin.

2017-10 1/4
2.2 Family Relationships - Please provide additional information in Section 3.
I have an immediate family member who currently works at SNC-Lavalin or I am in a close personal
relationship with someone who does. If you have checked this box, please provide the following information:
Your relationship with the employee:
Last name of SNC-Lavalin employee:
First name of SNC-Lavalin employee:
Additional information regarding family relationships can be provided in Section 3.
2.3 Government Officials

I am or was, or an immediate family member is or was, in the last 5 years, a government official. - If you have
checked this box, please complete all questions in Section 2.3.
The government official is a current government official.
OR
The government official is a former government official.
Your relationship with the government official:
Last name of government official:
First name of government official:
Position held by government official:
Organization where government official works/worked:
If a former government official, date at which government official left office:

(yyyy/mm/dd)
Country the government official represented and where organization is/was based:
Yes No
a. W
as the role and responsibilities of the current or former government official related to
procurement activities, proposal/bid evaluation or contract award?
b. W
as the current or former government official directly involved with or worked on an SNC-Lavalin
project while a government official?
c. D
id the position held by the current or former government official allow them to have direct, indirect
or potential influence on government decisions related to SNC-Lavalin’s business?
d. W
ould the position for which you are being considered allow you to directly, indirectly or potentially
influence government decisions or obtain advantages or preferred treatment in favour of SNC-
Lavalin?
e. Was the current or former government official:

An elected member of government (e.g. prime minister, president, minister, congressman, senator, deputy, mayor)?
A military officer?
An executive of a wholly or partially owned or controlled government entity or company?
A judge in a judicial or administrative court?

2017-10 2/4
2.4 Other Situations
I have a situation that is not addressed in this form. - Please provide additional information in Section 3.
I have nothing to declare.
3. Description of the Situation

If you have disclosed a conflict in Section 2 or have a situation that is not addressed in this form, describe it here as
well as any measures you may have taken or propose to take to eliminate or mitigate the situation:
4. Candidate Acknowledgment
This disclosure is truthful and any COI disclosed in this document constitutes a complete and accurate description
of the situation as I know it. I understand that my hire is conditional upon my disclosure of any actual or potential
COI, as well as any personal relationships I may have with a government official.
I agree to promptly advise SNC-Lavalin of any changes that may affect the declaration contained herein.
I understand that the original copy of this form will be kept in my file. I further consent to disclose this information to
the representatives of SNC-Lavalin Inc., its subsidiaries, affiliates and related companies.
Signature (please type your last name and first name)

I acknowledge and agree that completion of the following fields constitutes my electronic signature which is legally binding.
Last Name:
First Name:
Date:
(yyyy/mm/dd)
SUBMIT
Click Submit.
Once the email window opens, ensure your document is attached.
In the ‘To’ field, add your recipient’s email address.
Click Send.

2017-10 3/4
CONFIDENTIAL
Management Follow-Up
Reserved for Management/Human Resources
No measures necessary Measures required as described below
Candidate Acknowledgment of Remedial Measures

I acknowledge and understand that employment with SNC-Lavalin is conditional upon the implementation of the
remedial measures described above.
I declare that I will abide by these remedial measures and agree to promptly advise SNC-Lavalin of any changes that
may affect the declaration contained herein.
Signature: Date:
(yyyy/mm/dd)
Manager HR Representative
Last Name: Last Name:
First Name: First Name:
Signature: Signature:
Date: Date:
(yyyy/mm/dd) (yyyy/mm/dd)

2017-10 4/4

COI Form - Candidate EN - Rev PDF

Uploaded by

Copyright:

Available Formats

COI Form - Candidate EN - Rev PDF

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

COI Form - Candidate EN - Rev PDF

Uploaded by

Copyright:

Available Formats

CONFIDENTIAL

Conflict of Interest Disclosure Form for Candidates

2.1 Outside Employment or Activities - Please provide additional information in Section 3.

I have accepted or will be accepting a directorship or a non-executive position

Conflict of Interest Disclosure Form for Candidates

Your relationship with the employee:

Last name of SNC-Lavalin employee:

First name of SNC-Lavalin employee:

Additional information regarding family relationships can be provided in Section 3.

2.3 Government Officials

The government official is a current government official.

The government official is a former government official.

Your relationship with the government official:

Last name of government official:

First name of government official:

Position held by government official:

Organization where government official works/worked:

If a former government official, date at which government official left office:

e. Was the current or former government official:

Conflict of Interest Disclosure Form for Candidates

I have nothing to declare.

3. Description of the Situation

Signature (please type your last name and first name)

Conflict of Interest Disclosure Form for Candidates

Candidate Acknowledgment of Remedial Measures

Last Name: Last Name:

First Name: First Name:

Conflict of Interest Disclosure Form for Candidates

You might also like