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NOTIFICATION OF POST-EMPLOYMENT NEGOTIATION OR
AGREEMENT AND RECUSAL STATEMENT
Section 17 of the Stop Trading on Congressional Knowledge Act of 2012 (STOCK Act) requires certain employees to file a statement notifying their agency ethics official of any negotiation for or agreement of future employment or compensation with a non-federal entity within three business days after commencement of the negotiation or agreement. Employees who file this notification statement also must file with their agency ethics official a recusal statement whenever there is a conflict of interest or appearance of a conflict of interest with the entity. In any such case, the employee must recuse, unless the employee has first obtained a written waiver or authorization as discussed in 5 C.F.R. § 2635.605, or qualifies for a regulatory exemption pursuant to 18 U.S.C. § 208(b)(2).
NOTIFICATION OF POST-EMPLOYMENT NEGOTIATION OR AGREEMENT
Name of Employee
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Agency/Office
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Date Negotiation or Agreement Commenced
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Name(s) of Non-Federal Entity or Entities
Disclose each non-federal entity with which you are negotiating for or have an agreement of future employment or compensation.
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RECUSAL STATEMENT
For as long as I am negotiating for or have an agreement of employment or compensation with any entity listed above, I will not participate personally and substantially in any particular matter that has a direct and predictable effect on the financial interests of that entity, unless I first obtain a written waiver or an authorization consistent with 5 C.F.R. § 2635.605, or qualify for a regulatory exemption pursuant to 18 U.S.C. § 208(b)(2).
Employee Signature
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Date Submitted
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Agency Ethics Official Signature
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Date Received
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