disclosures: 05f5d835d64c5f1643ba0469dccecb1cc7427aab0dd1b32eb25455d120dfcabf
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| 05f5d835d64c5f1643ba0469dccecb1cc7427aab0dd1b32eb25455d120dfcabf | 2017/Santos,Ellen,_11.9.17_-_6.pdf | 2017 | Ellen Santos | Assabet Valley Regional Vocational School District | DISCLOSURE BY NON-ELECTED STATE EMPLOYEE OF FINANCIAL INTEREST AND DETERMINATION BY APPOINTING AUTHORITY RECEIVED AS REQUIRED BY G. L. C. 268A, § 6 TATE ETHICS COMMISSION STATE EMPLOYEE INFORMATION 2017 NOV =9 AM 11: 08 Name: Ellen Santos Title or Position: Director of Practical Nursing State Agency: Assabet Valley Regional Technical High School Agency Address: 215 Fitchburg St Marlborough, MA 01752 Office Phone: 508-263-9880 Office E-mail: esantos@assabet.org My duties require me to participate in a particular matter, and I may not participate because of a financial interest that I am disclosing here. I request a determination from my appointing authority about how I should proceed. PARTICULAR MATTER Particular matter Please describe the particular matter. E.g., a judicial or other I am the Director of Practical Nursing proceeding, application, We need a nurse with expertise in Labor and Delivery nursing to work 4 hours/week for 10 weeks as submission, request a temporary clinical substitute. for a ruling or other My daughter has the expertise and would like to do the temporary position. determination, contract, claim, controversy, The Superintendent Director Ernest Houle is the appointing authority. charge, accusation, Karen Sherman is the maternity instructor who would mentor the nurse. arrest, decision, Evaluations of the nurse would be done by the adult students for this experience. determination, or finding. Your required Please describe the task you are required to perform with respect to the particular matter. participation in the particular matter: My responsibility is to deliver the best experience to the students. To get an expert to work on a part time temporary basis is difficult. E.g., approval, disapproval, decision, I would be recommending her to the Superintendent for this work. recommendation, rendering advice, investigation, other. FINANCIAL INTEREST IN THE PARTICULAR MATTER Write an X by all that apply. I have a financial interest in the matter. My immediate family member has a financial interest in the matter. My business partner has a financial interest in the matter. I am an officer, director, trustee, partner or employee of a business organization, and the business organization has a financial interest in the matter. I am negotiating or have made an arrangement concerning future employment with a person or organization, and the person or organization has a financial interest in the matter. Financial interest Please explain the financial interest and include a dollar amount if you know it. in the matter My daughter would be paid the previously set rate of $45/ hour so has a financial interest of about $1800 for the 10 weeks. Employee signature: llen Santas Date: 10.31.17 DETERMINATION BY APPOINTING OFFICIAL APPOINTING AUTHORITY INFORMATION Name of Appointing Authority: Ernest F. Houle Title or Position: Superintendent-Director Agency/Department: Assabet Valley Regional Vocational School District Agency Address: 215 Fitchburg Street Marlborough, MA 01752 Office Phone: 508-263-9602 Office E-mail ehoule@assabet.org DETERMINATION Determination by As appointing official, as required by G.L. C. 268A, § 6, I have reviewed the particular matter and the appointing authority: financial interest identified above by a state employee. Write an I am assigning the particular matter to another employee, or by your selection. I am assuming responsibility for the particular matter, or I have determined that the financial interest is not so substantial as to be deemed likely to affect the integrity of the services which the Commonwealth may expect from the employee. Appointing Authority signature: Ernest 7 Homl Date: November 6, 2017 Comment: Supervision of the employee will be assigned to another Administrator. EHH 11/6/17 Attach additional pages if necessary. File copy with: State Ethics Commission, One Ashburton Place, Room 619, Boston, MA 02108 Form Revised February, 2012 | 2017/Santos,Ellen,_11.9.17_-_6.pdf |