Code of Ethics Attachment B

ATTACHMENT B

[AGENCY NAME]

CODE OF ETHICS

ANNUAL ACKNOWLEDGEMENT STATEMENT

My supervisor/manager and I have reviewed and discussed the [AGENCY NAME] – Code of Ethics. I understand that my signature on this document indicates that I have read and fully understand the prohibited activities and my professional ethical conduct responsibilities as an employee described in the [AGENCY NAME] – Code of Ethics.

Revised 04/11/2016

ATTACHMENT B

Employee Printed Name

Signature

E Date

Revised 04/11/2016

ATTACHMENT B

Revised 01/06/2016

ATTACHMENT B

Supervisor/Manager Printed

Signature

E Date

Revised 01/06/2016

ATTACHMENT B

Name

Revised 01/06/2016

ATTACHMENT B

Division

Section

E Unit

Revised 01/06/2016

ATTACHMENT B

Note to Supervisor/Manager: The review and discussion of the [AGENCY NAME] – Code of Ethic is an annual requirement. This signed document shall be submitted to Human Resources along with the employee’s annual performance evaluation.

Revised 01/06/2016