disclosures: 0164ac86f8b57fa1d87f38f88e52cbe0a67167677a0a1b413bb386e7739a7b42
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| 0164ac86f8b57fa1d87f38f88e52cbe0a67167677a0a1b413bb386e7739a7b42 | 2022/Hawley-Inacio_Theresa_8.15.22_-_7(d).pdf | 2022 | Theresa TheresaHawley-Inacid Hawley 2022 AUG 15 AH AM10: 53 | DISCLOSURE BY SPECIAL STATE EMPLOYEE OF FINANCIAL INTEREST IN A STATE CONTRACT AS REQUIRED BY G. L. C. 268A, ยง 7(d) SPECIAL STATE EMPLOYEE INFORMATION STATE ETHICS RECEIVED COMMISSION Name of special state employee: Theresa TheresaHawley-Inacid Hawley 2022 AUG 15 AH AM10: 53 I am a special state employee because: Put an X beside one I serve in a state position for which no compensation is provided. statement. 1 am not an elected official, and I earned compensation for fewer than 800 hours in the preceding 365-day period. By the classification of my position by my state agency or by the terms of a contract or my conditions of employment, I am permitted to have personal or private employment during normal business hours. 1 work for a company or organization which has a contract with a state agency, and 1 am a "key employee" because the contract identifies me by name or it is otherwise clear that the state is contracting for my services in particular, and the contract states that I am a special state employee or indicates that I meet one of the three requirements listed above. Title/ Position Assistant professor of Nursing at Springfield Technical Community College (position ending this month /August 2022) If you are a special state employee because a state agency has contracted with your company or Fill in this box organization, please provide the name and address of the company or organization. if it applies to you. State Agency/ This is "my State Agency." Department: springfield Technical community Colles Armory Square Springfield MA Agency Address: / Armory Square springfield MA 01105 Office phone: 413 781 7822 HR: 413-755-4489 Office e-mail: trhawleyinacib@stre.edu If tjlove abol@stec.edu Check one: Elected or Non-elected Starting date as a Iam leaving the STCC faculty position to work at Western special state employee. Mass Hospital this month la state DPH facility). the transition day should be simultaneous/ immodiate. Iam working at the BOX # 1 ELECTED SPECIAL STATE EMPLOYEE hospital starting 8/13/2 TRU I am an elected special state employee. Select either STATEMENT #1: I had a financial interest in a contract made by a state agency before I was STATEMENT #1 or elected to a compensated special state employee position. I will continue to have this financial STATEMENT #2. interest in a state contract. STATEMENT #2: I will have a new financial interest in a contract made by a state agency. My financial interest in a contract made by a state agency is: Write an X A compensated, non-elected position with a state agency. by your financial A contract between a state agency and myself. interest. A financial benefit or obligation because of a contract that a state agency has with another person or with a company or organization. Other work because a state agency has a contract with my company or organization and I am a "key employee" because the contract identifies me by name or it is otherwise clear that the state is contracting for my services in particular. BOX #2 NON-ELECTED SPECIAL STATE EMPLOYEE I am a non-elected special state employee (compensated or uncompensated). STATEMENT #1: I had a financial interest in a contract made by a state agency, other than an Select either employment contract, before I took a non-elected, compensated special state employee STATEMENT #1 or position. I will continue to have this financial interest in a state contract. STATEMENT #2. My financial interest in a contract made by a state agency is: A contract between a state agency and myself, but not an employment contract. Write an X by your financial A financial benefit or obligation because of a contract that a state agency has with another interest. person or with a company or organization. OR STATEMENT #2: I will have a new financial interest in a contract made by a state agency. My financial interest in a contract made by a state agency is: A compensated, non-elected position with a state agency. A contract between a state agency and myself. A financial benefit or obligation because of a contract that a state agency has with another person or with a company or organization. Other work because a state agency has a contract with my company or organization and I am a "key employee" because the contract identifies me by name or it is otherwise clear that the state is contracting for my services in particular. FINANCIAL INTEREST IN A STATE CONTRACT Name and address of state agency that position at Western Mass Hosp ital as After I start that This is the "contracting agency." I will be starting a 3a hR staff nurse made the contract job, I will be parttime ladjunct clinical faculty are day weekly atSTCC. Write an X to confirm In my work as a special state employee for my State Agency, I do not participate in or have this statement. official responsibility for any of the activities of the contracting agency. ANSWER THE QUESTION IN THIS BOX FILL IN IF THE CONTRACT IS BETWEEN THE STATE AGENCY AND YOU. THIS BOX OR - Please explain what the contract is for. THE NEXT BOX I am finishing my 2021-2022 academic year facutes posotion contract for STC Call work wa completed may- payment is Spread out over a calovdar September to August I year. am starting a new staff wmtt. | 2022/Hawley-Inacio_Theresa_8.15.22_-_7(d).pdf |