"Marriage Disclosure Form for State Employees" - Arkansas

Marriage Disclosure Form for State Employees is a legal document that was released by the Arkansas Department of Transformation and Shared Services - a government authority operating within Arkansas.

Form Details:

  • Released on November 25, 2020;
  • The latest edition currently provided by the Arkansas Department of Transformation and Shared Services;
  • Ready to use and print;
  • Easy to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of the form by clicking the link below or browse more documents and templates provided by the Arkansas Department of Transformation and Shared Services.

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Department of Transformation and Shared Services
Office of Personnel Management
Marriage Disclosure Form For State Employees
In Compliance with Arkansas Code Annotated § 25-16-1001
I understand that after August 12, 2005 I may be in violation of Arkansas Code Annotated § 25-16-1001 if I marry another
state employee within my line of supervision whereby one relative would be a supervisor of the other relative. I further
understand that the violation will be resolved by:
1. Transferring one of the employees to another position within the agency;
2. Transferring one of the employees to another agency; or
3. The resignation of one of the employees
Please note: There is no guarantee that a position will be available within the employee’s current agency, or
another agency.
If the employees are unable to agree upon an alternative within sixty days, the public official shall choose from the
alternatives to correct the violation.
Will this marriage result in a violation of ACA §25-16-1001?
Yes. Please indicate which of the 3 options listed above will be used to resolve the conflict:
No.
Names of employees who plan to marry:
Printed Name: ______________________________________ Personnel Number: ________________
Job Title: __________________________________________ Division/Section: _________________________
Signature: _________________________________________
Date: ______________
Printed Name: ______________________________________ Personnel Number: ________________
Job Title: __________________________________________
Division/Section: _________________________
Signature: _________________________________________
Date: ______________
This section to be completed by Agency Human Resources Department.
Date Received_________________________Reviewed by_____________________________________
Does violation exist? (Yes/No)____________________________________________________________
If yes, explain resolution ________________________________________________________________
____________________________________________________________________________________
Marriage Disclosure Form Revised 11/25/2020
Department of Transformation and Shared Services
Office of Personnel Management
Marriage Disclosure Form For State Employees
In Compliance with Arkansas Code Annotated § 25-16-1001
I understand that after August 12, 2005 I may be in violation of Arkansas Code Annotated § 25-16-1001 if I marry another
state employee within my line of supervision whereby one relative would be a supervisor of the other relative. I further
understand that the violation will be resolved by:
1. Transferring one of the employees to another position within the agency;
2. Transferring one of the employees to another agency; or
3. The resignation of one of the employees
Please note: There is no guarantee that a position will be available within the employee’s current agency, or
another agency.
If the employees are unable to agree upon an alternative within sixty days, the public official shall choose from the
alternatives to correct the violation.
Will this marriage result in a violation of ACA §25-16-1001?
Yes. Please indicate which of the 3 options listed above will be used to resolve the conflict:
No.
Names of employees who plan to marry:
Printed Name: ______________________________________ Personnel Number: ________________
Job Title: __________________________________________ Division/Section: _________________________
Signature: _________________________________________
Date: ______________
Printed Name: ______________________________________ Personnel Number: ________________
Job Title: __________________________________________
Division/Section: _________________________
Signature: _________________________________________
Date: ______________
This section to be completed by Agency Human Resources Department.
Date Received_________________________Reviewed by_____________________________________
Does violation exist? (Yes/No)____________________________________________________________
If yes, explain resolution ________________________________________________________________
____________________________________________________________________________________
Marriage Disclosure Form Revised 11/25/2020