SHARED SERVICES

RECRUITMENT SELECTION COMMITTEE

DECLARATION OF IMPARTIALITY

Note: Please save this form prior to filling out, to ensure the proper functionality of the form.

The purpose of this document is to facilitate fair, proper, and efficient operation of Recruitment Selection Committees constituted under the Public Sector Management Act 1994. Shared Services requires all persons nominated as members of Recruitment Selection Committees to make this declaration.

This form is to be completed following an initial screening of applicants and prior to the commencement of shortlisting. You are required to read the Shared Services Workplace Relationships Conflict of Interest Policy prior to the completion of this Declaration. The completed Declaration is to be sent to Shared Services Strategic HR and Corporate, for future reference as necessary.

I, (full name) of (workplace), as a member of the Recruitment Selection Committee for the vacancy of PN , (job vacancy title), in (Business Unit),

have read and understand the Shared Services Workplace Relationships Conflict of Interest Policy:
Yes	or No

having regard for the type of relationships that might cause an actual or perceived conflict of interest in a recruitment process such as:

a family or personal relationship; or

a business relationship (for example, with outside vendors); or

a relationship involving personal conflict.

DECLARE THAT (please select ONE of the boxes below):

I do not have or previously had a relationship of a kind described above, with any applicant to the specified vacancy; or

I have disclosed and described the circumstances of an actual or perceived conflict of interest due to a relationship as described above with an applicant/s, as follows:

Applicant:
Click here to provide circumstances of the conflict of interest.

Applicant:

Click here to provide circumstances of the conflict of interest.

acknowledge that the recruitment selection process is confidential and will not divulge information to applicants during this process.

Signature:	Date:

Note: Please forward the completed form to the chairperson of the Recruitment Selection Committee, who will forward the form to the Recruitment Delegate for review and completion of the next section.

If a conflict of interest has been disclosed, the Recruitment Delegate will discuss the circumstances of the conflict of interest/s with you to determine your suitability for the Recruitment Selection Committee.

The form, once signed, is to be sent to Shared Services Strategic HR and Corporate, for future reference as necessary.

RECRUITMENT DELEGATE TO COMPLETE:

CONFLICT OF INTEREST: NO DISCLOSURE

I,	(full name) as Recruitment Delegate, am satisfied that there (please select where appropriate) a conflict of interest that may affect the integrity of the recruitment process. I have determined that the member remain on the Recruitment Selection Committee because (please provide reasons if the person is removed from the Committee):

Click here to provide reasons.

Signature: Date:

CONFLICT OF INTEREST: DISCLOSURE MADE

I,	(full name) have discussed the circumstances of the conflict of interest/s with the member and as Recruitment Delegate, I am satisfied that there (please select where appropriate) a conflict of interest that may affect the integrity of the recruitment process. I have determined that the member remain on the Recruitment Selection Committee because (please provide reasons):

Click here to provide reasons.

Signature: Date: