Can I e-sign the questionnaire?

Yes. Electronic signatures satisfy federal ESIGN and state UETA rules where applicable, provided intent, consent, attribution, and retention are documented. Ensure the platform captures an audit trail and retention for reproducing the signed record.

Who must sign the form?

The employee or contractor completing the disclosure must sign to attest accuracy. A manager or compliance officer may sign only when the form requires approval or documents mitigation steps.

What happens if I need to change a submitted disclosure?

Submit an amended disclosure noting the change and date; reviewers should treat it as an update and document whether it alters prior mitigation. Avoid altering archived signed records without an addendum.

How is confidentiality maintained?

Limit access to disclosures by role-based permissions, redact sensitive personal data for wider distribution, and store originals in secure systems with encryption at rest and in transit.

Are notarization or witnesses required?

Most employer COI questionnaires do not need notarization or witnesses. Public officials or sworn statements may have special state filing rules; consult the applicable state ethics agency.

How long must we retain disclosures?

Follow retention policies tied to employment and regulatory obligations: commonly keep records for at least three to seven years; healthcare-related records require six years under HIPAA.

Electronic Signature
Templates
HR
HR COI Questionnaire

HR COI Questionnaire

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

HR COI QUESTIONNAIRE

Personal Information

Full Legal Name Home Address

Phone:

Email:

Position Information

Current Job Title Department

Manager / Supervisor:

Start Date:

Conflict of Interest Declaration

This Conflict of Interest Questionnaire is intended to identify any actual, potential, or perceived conflicts between personal interests and the interests of the company. Disclose all relevant activities, relationships, financial interests, and outside employment that reasonably could affect or appear to affect your duties. If none, indicate "None" in the applicable detail fields.

1. Do you have any direct or indirect ownership, investment, or financial interest in any organization that does or seeks to do business with the company? Yes No

If yes, describe entity, nature of interest, percent ownership, and estimated value

2. Are you currently engaged in outside employment, consulting, board membership, or volunteer roles that could conflict with your duties? Yes No

If yes, list organizations, role, time commitment, and whether you seek or accept compensation

3. Do you have any family members, domestic partners, or household members who are employed by, own, or have a decision-making role with any vendor, contractor, or competitor of the company? Yes No

If yes, identify the person, relationship, employer, position, and nature of potential conflict

4. Have you received gifts, meals, travel, entertainment, or other favors from a supplier, customer, or other third party that exceed nominal value or that could be perceived to influence business decisions? Yes No

If yes, describe the nature of the gift, donor, approximate value, and date received

5. Do you or an immediate family member hold a position of authority (officer, director, manager) in any organization that competes with or seeks to do business with the company? Yes No

If yes, identify the organization, position held, and potential overlapping responsibilities

Additional Disclosures

6. Are you aware of any other activity, investment, relationship, or obligation not previously described that could be perceived as a conflict of interest? Yes No

If yes, provide full details and any supporting documentation available Proposed mitigation or resolution (if any). If you request a waiver, explain basis and duration requested.

Employment History (Most Recent Two Employers)

Employer #1 — Company Name Title / Position

Dates Employed:

Reason for Leaving:

Primary Responsibilities

Employer #2 — Company Name Title / Position

Dates Employed:

Reason for Leaving:

Primary Responsibilities

Education

Highest Degree Earned Institution Graduation Date

Professional References (3)

Reference 1 — Name

Phone:

Email:

Relationship

Reference 2 — Name

Phone:

Email:

Relationship

Reference 3 — Name

Phone:

Email:

Relationship

Legal Disclosures & Authorizations

At-Will Employment: Nothing in this questionnaire alters the at-will nature of employment. Either the employee or the company may terminate employment at any time, with or without cause or notice, unless otherwise agreed in a separate written agreement signed by authorized company representatives.

Equal Opportunity Statement: The company provides equal employment opportunity and does not tolerate discrimination or harassment based on protected characteristics. Completion of this form will be handled in a manner consistent with privacy and anti-discrimination obligations.

Authorization to Investigate: By signing below, you expressly authorize the company and its authorized agents to contact references, prior employers, and any third parties identified in this form to verify the information provided. You also authorize background checks, credit checks where job-related and permitted by law, and other verifications as necessary to evaluate conflicts of interest.

Applicant Certification

I certify that all information contained in this Conflict of Interest Questionnaire is true, complete, and accurate to the best of my knowledge. I agree to promptly update this disclosure in writing if circumstances change. I understand that failure to fully disclose material conflicts or providing false information may result in disciplinary action up to and including termination of employment.

Employee Acknowledgment (Type your full name to acknowledge)

Printed Name:

Signature:

Date:

What the HR COI Questionnaire Covers

The HR COI Questionnaire is a standardized employee disclosure form used to identify potential conflicts of interest involving outside employment, financial interests, gifts, family relationships, or vendor ties. Organizations use it to document employee declarations, assess risk, and route matters to HR or compliance for review. The form typically collects identifying details, role and department, specific conflict descriptions, dates, and any mitigating actions or approvals. Many employers integrate the questionnaire into onboarding, annual reviews, and project assignments to maintain transparency and to support regulatory or internal policy compliance.

Why a COI Questionnaire Matters for Employers

A clear COI questionnaire helps prevent undisclosed conflicts that can harm reputation, create legal exposure, and skew procurement or hiring decisions. It supports consistent evaluations, documents mitigation, and provides an auditable record for HR and compliance teams.

Who completes and reviews the HR COI Questionnaire

The questionnaire is completed by employees, contractors, and applicants when prompted during onboarding, role changes, or periodic reviews.

HR teams and people managers review disclosures and track remediation steps across the workforce.
Compliance officers or ethics teams assess material conflicts and decide on recusals or mitigation.
Employees and contractors must report applicable interests, changes, and relationships in a timely manner.

Maintain a consistent review cadence and clear escalation path so disclosures are evaluated uniformly and decisions are documented.

Core sections to include in a professional questionnaire

A complete HR COI Questionnaire organizes information to speed review and support defensible decisions while preserving privacy controls.

Identification

Employee name, title, department, work email and employee ID; used to link the disclosure to HR records and access controls.

Disclosure Items

Structured yes/no prompts for outside employment, board positions, equity interests, vendor relationships, gifts, and family ties.

Detailed Description

Free-text field to explain the nature, parties, monetary amounts, and timelines for each reported interest or activity.

Impact Assessment

Questions about involvement in procurement, hiring, or decision-making where the disclosed interest could influence outcomes.

Mitigation Actions

Options to record recusal plans, reporting lines changes, approvals, or other controls applied by HR or compliance.

Signatures & Date

Acknowledgment checkbox and signature block with date to evidence intent and attestation to accuracy of the disclosure.

Step-by-step: completing and routing a COI questionnaire

Follow this sequential guide every time you submit or process a COI form to ensure consistent handling and timely decisions.

01

Fill Form: Complete all mandatory fields and provide clear descriptions.
02

Sign Attestation: Sign and date to confirm accuracy and consent to review.
03

Route to Reviewer: Send to HR or compliance via the established digital workflow.
04

Document Outcome: Record mitigation, approvals, or escalations in the employee file.

Configuring an online COI questionnaire workflow

Configure form fields, authentication, and retention so submissions are secure, auditable, and routed correctly.

Form Field Configuration and Values	How to configure field behavior
Signature Field Type and Options	eSignature compliant with ESIGN and UETA requirements
Authentication Method, Strength, and Options	Email link default; enable SMS code or knowledge-based auth
Conditional Field Logic and Visibility Rules	Show follow-up questions only when a conflict box is checked
Retention and Export Settings for Records	Archive signed form for six years; enable secured PDF export

Where to send and how submissions are processed

Understand the typical routing so employees know where disclosures go and reviewers know how to act on them.

Prepare Form: HR configures questions and mandatory fields for the role.
Send to Signer: Employee receives an email link or completes the questionnaire in the HR portal.
Review & Decide: Compliance or manager evaluates risk and selects mitigation.
Record Outcome: Final decision and documents are stored in the employee record.

Digital signing and system requirements

Choose a platform that supports secure eSignature, audit trails, conditional fields, and integrations with HRIS or document storage.

Authentication Options: Email, SMS, or stronger methods available
Document Formats: Supports PDF, DOCX, HTML, and exports
Integrations: Connects to HRIS, Google Workspace, and NetSuite

Ensure the chosen platform supports retention controls, role-based access, and audit logs so disclosures remain secure and retrievable for compliance reviews.

Timelines for submission and review

Set clear deadlines so disclosures are timely and reviews complete before critical decisions or contract changes.

Onboarding Submission Deadline:

Complete before or within first 7 days of employment

Annual Recertification Window:

Complete once per 12-month period, per policy

Event-Driven Update Requirement:

Report new conflicts within 30 days of change

Reviewer Response Time:

Compliance decision typically within 14–30 days

Record Retention Trigger:

Retention begins on signed date or event closure

Common mistakes to avoid when preparing disclosures

Providing vague descriptions that lack names, dates, or financial amounts reduces the ability to assess actual risk and prolongs review cycles.
Failing to update disclosures after a role change or new outside engagement creates stale records and potential compliance gaps.
Using different name formats than payroll causes identity mismatches and delays in linking disclosures to employee files.
Skipping the signature or date field results in incomplete forms that may be rejected or require manual follow-up.

Consequences of incorrect or omitted disclosures

Employment Action: Warnings, suspension, or termination

Contract Rescission: Agreements may be voided

Regulatory Risk: Fines or enforcement exposure

Reputational Harm: Damage to employer trust

Financial Liability: Repayment or damages

Audit Findings: Increased oversight or reports

Real-world examples of COI questionnaires in use

Two practical scenarios show how questionnaires guide disclosure, review, and remediation.

University Example

A faculty member reports consulting income from a vendor

The committee assesses the research overlap
The university documents a management plan, requires disclosure in publications, and monitors compliance for the project duration.

Clinical Research Example

A clinician discloses equity in a study sponsor

Compliance flags potential enrollment conflicts
The site imposes recusal from participant recruitment and documents the mitigation steps in the trial record for auditors.

Primary roles that sign and approve the questionnaire

HR Manager

HR managers administer the questionnaire, ensure form completion, route disclosures for review, and maintain records in the HRIS. They coordinate remediation steps and communicate policy expectations to employees.

Compliance Officer

Compliance officers evaluate materiality, approve mitigation plans, and maintain audit trails for investigations and external reporting. They ensure the questionnaire aligns with legal and regulatory obligations.

eSignature vendor pricing and capability snapshot for COI workflows

Comparing core pricing and features helps choose an eSignature provider that supports secure COI collection, audit trails, and retention. signNow appears first for reference.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day trial	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	Varies
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No
Envelope Cap	No cap	100 envelopes/user/yr	Varies	Varies	Varies

Common questions about using the HR COI Questionnaire

Answers to frequent questions about e-signing, recordkeeping, and disclosure handling for HR teams and employees.

Need help? Contact support

Can I e-sign the questionnaire?
Yes. Electronic signatures satisfy federal ESIGN and state UETA rules where applicable, provided intent, consent, attribution, and retention are documented. Ensure the platform captures an audit trail and retention for reproducing the signed record.
Who must sign the form?
The employee or contractor completing the disclosure must sign to attest accuracy. A manager or compliance officer may sign only when the form requires approval or documents mitigation steps.
What happens if I need to change a submitted disclosure?
Submit an amended disclosure noting the change and date; reviewers should treat it as an update and document whether it alters prior mitigation. Avoid altering archived signed records without an addendum.
How is confidentiality maintained?
Limit access to disclosures by role-based permissions, redact sensitive personal data for wider distribution, and store originals in secure systems with encryption at rest and in transit.
Are notarization or witnesses required?
Most employer COI questionnaires do not need notarization or witnesses. Public officials or sworn statements may have special state filing rules; consult the applicable state ethics agency.
How long must we retain disclosures?
Follow retention policies tied to employment and regulatory obligations: commonly keep records for at least three to seven years; healthcare-related records require six years under HIPAA.

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