NEW STAFF

CONFLICT OF INTEREST DECLARATION FORM

Name: Alemayehu Alula Rikitu

Index # (if known): ______________

Functional Title: Driver

Business Unit and Duty Station: Driver for Addis Ababa

Grade Level: GII Date: August 1, 2023

It is the policy of the United Nations Development Programme (hereafter “UNDP” or the “Organization”) that in
the exercise of your functions, you must avoid even the appearance of impropriety. As a UNDP staff member, you
have an obligation to avoid situations in which your personal interests might conflict, or appear to conflict, with
the interests of UNDP. Conflicts of interest may arise when, by act or omission, a staff member’s personal
interests interfere with the performance of his or her official duties and responsibilities or with the integrity,
independence and impartiality required by the staff member’s status as an international civil servant. When an
actual or possible conflict of interest does arise, you must disclose the conflict to your head of office, the Ethics
Office or Office of Human Resources, mitigated by the Organization (if possible) and resolved in favour of the
interests of the Organization, so as to avoid reputational and other damage to UNDP.

The existence of a potential conflict of interest does not necessarily imply any wrongdoing. Potential conflicts of
interest may arise in the course of your work or in the course of your relationships. The important consideration is
to recognize a potential conflict of interest situation and take appropriate steps to avoid having that potential
conflict impact or appear to impact your official responsibilities. By promptly disclosing potential conflicts of
interest, you can receive advice and guidance and avoid remaining in a situation where your judgment can be, or
reasonably appear to be, improperly influenced.

Please read the form carefully and be certain to complete all sections even if you have no relationships to
disclose. Accurate completion of this form is mandatory. Any intentional omission or misrepresentation can be
grounds for disciplinary action, or termination. The completed form should be printed, signed and submitted to
the Office of Human Resources (OHR). Where the information disclosed raises a potential conflict of interest, the
information will be forwarded to the Ethics Office for advice and guidance on how to manage or mitigate the
conflict of interest.

While all information will be kept confidential except to the extent necessary to administer the program, please
note that your supervisor may also personally review your completed forms in order to avoid assigning you work
or responsibilities that may inadvertently place you in a conflict situation. Also note that you are obligated to
provide UNDP with immediate notice of any changes to this information, in writing, to the Directors of OHR and
the Ethics Office with a copy to your immediate supervisor.

Your cooperation in this process is essential. Please direct any questions to your OHR recruiter, who may reach
out to the Ethics Office for further guidance as needed.

September 2013
1. Do YOU or any Immediate Family Member or Relativeⁱ Yes: No: If yes, please give details in the box
have any financial or other ownership interest² in, or affiliation below.
with, any entity with which you may be required to have official
dealings on behalf of UNDP,³ or which has a commercial interest 6. Do you have any Immediate Family Member or
in the work of UNDP, or a common area of activity with UNDP? Relative who is currently employed by a national
government as a staff member or is an elected or
Yes: No: If yes, please give details in the box appointed government official, or is a public or civil
below. servant?

2. Do YOU now hold (or have held at any time in the past) Yes: No: If yes, please give details in the box
any executive, leadership or policy-making role in any non-UNDP below.
entity including, but not limited to, any NGO, intergovernmental
entity, non-profit, for profit, charity, or academic institution (e.g., 7. Do you have any Immediate Family Member or
membership on corporate or advisory boards, or as a trustee of Relative who is currently employed by a UNDP vendor,
such entity)? supplier, provider, partner, agent, NGO or
contractor/consultant, or by an individual or entity that
Yes: No: If yes, please give details in the box seeks to have or currently maintains a business
below. relationship with UNDP, not previously disclosed
pursuant to the foregoing questions?
3. Do you have any Immediate Family Members or
Relatives who hold any executive, leadership or policy-making Yes: No: If yes, please give details in the box
role in any non-UNDP entity including, but not limited to, any below.
NGO, intergovernmental entity, non-profit, for profit, charity, or
academic institution (e.g., membership on corporate or advisory 8. If hired by UNDP, will YOU maintain any full or
boards, or as a trustee of such entity)? part-time employment with any entity other than
UNDP?
Yes: No: If yes, please give details in the box
below. Yes: No: If yes, please give details in the box
below.
4. Are YOU now or have you at any time been a staff
member of, or held any elected or appointed official position 9. Are YOU now, or have you ever been involved in any
with, a national government, or as a public or civil servant? other activity which could be potentially viewed as influencing
your objectivity or independence in the performance of the
Yes: No: If yes, please give details in the box functions of the position for which you have been
below. recruited/contracted by UNDP, or which could otherwise
negatively affect the image of UNDP?
5. Do you have any Immediate Family Member or Relative
who is currently employed within the UN system? Yes: No: If yes, please give details in the box
below.

(Add a separate piece of paper if more room is needed)

I hereby declare that the disclosed information is correct and complete to the best of my knowledge and belief. I recognize that, if hired, any failure
to disclose information that is true and accurate may result in disciplinary action or termination of contract.

_________________________________________
Signature & Date

Immediate Family Member or Relative includes spouse, children, parents and siblings.
2
Examples of such interests are: (a) A proprietary interest, e.g., ownership of a patent, relevant to the work of the United Nations; (b) A financial interest in
a commercial entity (e.g., a current or potential UNDP vendor, supplier, provider, partner, agent, NGO, contractor/consultant) except through mutual funds or
similar arrangements; (c) A full or part-time employment, a consultancy, directorship, or other position or association, whether paid or not, in any entity, or an
ongoing negotiation concerning prospective employment or other association with such entity; and (d) Ongoing performance of any paid work or research
commissioned by an entity or passive award of commissions or other compensation from such affiliation, whether you remain active in it or not.

September 2013
 When identifying entities with which a staff member “may be required” to have dealings, any entities in which it is reasonably possible during the course of the staff
member’s official duties that he/she might be called upon to have contact, even though no such contact is immediately foreseen, should be included. Of course, if what
was reported as a mere possibility of future contact actually materializes as an impending contact, the staff member should immediately report this fact to UNDP in
advance of undertaking any actual contact

September 2013