HTML version of the form: Post-Employment Declaration

Warning

In accordance with National Defence Security Policy, the form titled DND 2840-E- Post-Employment Declaration is designated "Protected B" information once completed.

Completed "Protected B" forms must not be saved unencrypted on any network and workstation drive or storage media. "Protected B" forms, when completed, must be encrypted using the Department of National Defence (DND) issued Public key infrastructure (PKI) Smartcard. Failure to respect this requirement will result in a breach of security and sanctions shall be applied in accordance with the policy.

Protected B (When completed)

Defence Administrative Orders and Directives (DAOD) Form 7021-2A

Post-Employment Declaration

When completed, forward to: Chief Review Services, Attention: Director Defence Ethics Programme/Conflict of Interest (DDEP/COI), National Defence Headquarters (NDHQ), MGen George R. Pearkes Building, Ottawa ON K1A 0K2. Secure email at: COIDEP-CIPED@forces.gc.ca.

  • Service number or Personal Record Identifier (PRI)
  • Rank or Classification
  • Surname, Name and initials
  • Command, Formation or Base, or Branch or Division
  • Position
  • Current or last position occupied
  • Public service retirement or Cessation of employment date
  • Canadian Forces (CF) Retirement date
  • CF Release date
  • Accepted Cash-Out or Terminal Benefits:
    • Yes
    • No
  • Telephone (Office)
  • Address (where you want the Defence Ethics Programme/Conflict of Interest (DEP/COI) reply letter to be sent)
  • Telephone (Other)
  • Email

Note: If space below is insufficient, attach a second page.

  1. Name of prospective employer.
  2. Title and duties of position being offered or acceped.
  3. Proposed date of commencement of employment.
  4. List all areas in the DND and the CF where you worked or had specific involvement in the past year (or during the year preceding your departure) and describe the nature of the work.
  5. List all government departments and agencies with which you personally, or through your subordinates, had significant official dealings in the past year (or during the year preceding your departure).
  6. Describe any significant official dealings you personally, or through your subordinates, have had with this prospective employer in the past year (or during the year preceding your departure from the DND or the CF). Attach written certification by your supervisor (or former supervisor) acknowledging the accuracy of these details.
  7. List and describe the nature of any current business between the prospective employer and the DND and the CF. Please detail the full nature of any such business arrangements, including the type of business arrangements, the location and timing of any work or undertaking, and the value of any goods or services to be rendered.
  8. Describe any plans by the prospective employer to engage in future business dealings with the DND and the CF. Detail the full nature of any such business intentions, including the type of business, the proposed location and timing of any work or undertaking, and the anticipated value of any goods or services to be rendered.
  9. Describe any requirement for you to make representations for or on behalf of your prospective employer to the DND and the CF or other federal government departments.
  10. Describe any requirement for you to give advice to your prospective clients or employer using information learned or obtained through the course of your duties which is not generally available to the public.

Privacy Act Statement: The information you provide on this document is Protected B once completed and will be stored in personal information banks DND PPE 864 - Conflict of Interest and Post-Employment Code - Military for CF members and DND PPE 915 Conflict of Interest and Post-Employment Code - Civilian for DND employees. Personal information that you provide is protected under the provisions of the Privacy Act.

In accordance with paragraph 8(2)(a) of the Privacy Act, personal information may be disclosed for a use consistent with the purpose for which it was obtained or compiled. For the purpose of the information collected in this Post-Employment Declaration form, information may be disclosed to your new employer or supervisor, or both.

I agree to the disclosure of this personal information in accordance with paragraph 8(2)(a) of the Privacy Act.

  • Signature
  • Date

DND 2840-E (11-2012) CLF 2.0

Design: Forms Management 613-957-6899 / 613-957-6906

Formulaire disponible en Français - DND 2840-F

Protected B (When completed)

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