FAMILY RELATIONSHIP DISCLOSURE FORM

Employee’s Name:

Job Title/Position:

Employment Date: ___ Full-Time □ Part-Time □

Salary Schedule: Rank: Step: Annual Salary:

For the purposes of disclosure, relative includes any person related within the fourth degree of
affinity or consanguinity to any job, position, or office of profit with state or with any of its
agencies.

Are you a relative of any employee of the Alabama Community College System or any member of
the Alabama Community College System Board of Trustees?

Yes □ No □

If yes, list the name(s), relationship, and employer or the position of the relative(s)

My signature below affirms that all information contained herein is correct to the best of my
knowledge.

_____________________________ ____________________________
Employee’s Name Printed Employee’s Signature

_________________________________
Date

*Please see reverse side for an illustration defining relatives to the fourth degree.

Revised September, 2017

 IMMEDIATE FAMILY MEMBERS
C 4th Degree Great Great Grandparent
O Great Aunt/Uncle
N First Cousin
S Grand Nephew/Niece
A 3rd Degree Great Grandparent
N Aunt/Uncle
G Niece/Nephew
Great Grandchild
U
2nd Degree Grandparent
I
Brother/Sister
N Grandchild
I
1st Degree Parent
T
Child
Y
YOU
1st Degree Spouse
A
F
2nd Degree Parent-in-Law
F
Daughter/Son-in-Law
I
N 3rd Degree Grandparent-in-Law
I Brother/Sister-in-Law
T Grandchild-in-Law
Y
4th Degree Great Grandparent-in-Law
Aunt/Uncle-in-Law
First Cousin-in-Law
Niece/Nephew-in-Law
Great Grandchild-in-Law
Note: Step relationships (step-brother, step-father, etc.) are considered to be
the same as blood relationships.