Conflict of Interest in Hiring Disclosure form

This form is for

 applicants (internal and external) applying for a role with Air Products who must disclose
relationships that are or may be perceived as conflicts of interest, and
 employees who want to notify Air Products about a relationship they have with an applicant.

Additional information on purpose and process can be found in our Global TA Policy and Global TA
Procedure. Please complete the fields below and provide any relevant information regarding the conflict
of interest to initiate the required evaluation.

Information contained in this form will be handled and treated as confidential and used only for the
specific purposes of the Air Products Conflict of Interest business for which it was made available.

We foster an inclusive environment where everyone can thrive regardless of their race, color, religion,
national origin, age, citizenship, gender, marital status, pregnancy, sexual orientation, gender identify
and expression, veteran status, or physical or mental disability.

Please share the completed and signed form with your manager/supervisor, and if you are an external
applicant, with your Talent Acquisition contact.

Applicant Name : Employee Number (if applicant is a current

Raj Kumar Singh employee):

☒ I have applied for the following role with Air Products: ……………………………….(please include role
you have applied for). I herewith notify the company that I am in a relationship with the following Air
Products employee: ……………………………….. (please include first and last name).

☒ I herewith notify the company that the above mentioned applicant has applied for a role with Air
Products and that I am in a relationship with this applicant.

Please check below to indicate the nature of the relationship(s):

 Relative (please mark): ( ) Spouse/Domestic partner ( ) Parent or Parent-in-law
( ) Child/Stepchild ( ) Sister/Brother ( ) Sister/Brother-in-law ( ) Grandparent
( ) Grandchild ( ) Aunt/Uncle ( ) Niece/Nephew ( ) Other
 None of the above, but a personal relationship: (please mark):
( ) Dating ( ) Sharing the same household ( ) Other, please specify:

Air Products Internal Use Only

 Please provide any information that may be relevant for the evaluation:

I hereby certify the above information is true and complete to the best of my knowledge. I have read,
understand, and agree to abide by the Air Products Conflict of Interest policy.

Print name Date:

Signature

Air Products Internal Use Only