Employment of or Consulting Agreements
with Current and Former Public Officials
In accordance with Rutgers Policy Section 60.1.14, Employment of Current and Former Public Officials, this
form must be completed in full when hiring or entering into consulting agreements with current or
former federal, state, and local elected and appointed government officials. Former public officials are
defined as those who have held office or other public positions within three years of their Rutgers
employment or engagement. Completed forms must be returned to University Human Resources, ASB II,
Cook Campus within 30 days of appointment or engagement.
Employee’s Name: ____________________________________________________________________________
Position: _____________________________________________
Appointment Date: __________________
Department: ________________________
Appointment Length: ________________
Position Type:  Regular/salaried
 Casual/hourly
 Consultant/Contractor
Public Office: _________________________________________
Dates in Public Office: _______________
Description of Duties:
Authorized by:
Dean/Director/Department Head: _______________________________________________________________
(Print name)
Signature: ________________________________________
Date: ______________________________
University Human Resources
57 U.S. Highway 1  New Brunswick, NJ 08901-8554
732-932-3020  FAX 732-932-0046  uhr.rutgers.edu
policy60114form.doc