CHILDREARING STOP THE CLOCK REQUEST/CERTIFICATION FORM

NameDepartment

Date of initial appointment:

I.Instructions: To provide notice of your intent to“stop the clock” or extend the maximum service limit (eight-year rule) in your title, as described in APM 133 and APM 760, please complete Section II below and sign the certification of eligibility statement. You will receive written acknowledgement from Academic Affairs.

Please note that appointees are not guaranteed eight years of employment under the eight-year rule. Rather, the eight-year limit refers to the maximum time in which the University may offer employment in the Assistant Professor title. Reappointment and merit reviews will occur on schedule and will be based on careful assessment of your promise, progress, and achievement in the normal review period. YourStop the Clock may, however, have the effect of lengthening the time during which you are a candidate for midcareer appraisal or promotion. If this is the case, normal progress will be expected for a positive review, but the work completed over an extended period of timewill be evaluated without prejudice as if it were done in the normal period.

II.Under the provisions of APM 133-17-h, I wish to request an option to stop the clock on the eight-year probationary period for one/two/three/four (circle one) quarters. (NOTE: The fourth quarter is for fiscal year appointees only.) I understand that combined exclusions/extensions due to childbearing leave, parental leave, and childrearing may not exceed one academic year for each event of birth or adoption and may total no more than two years overall. I also understand that I may choose to stand for review at the normal time, if I decide not to exercise this extension. I further understand that in order to exercise this option I must inform my chair in writing no later than the second half of my actual fifth year.

Date of qualifying birth or adoption:

(must be within two years of this notification)

Dates of the period of 50% or moreresponsibility: to

Brief description of the circumstances indicating 50% or more responsibility:

I hereby certify that the above statements are true, and I am responsible for 50% or more of the child care.

SignatureDate

III.ACKNOWLEDGEMENTS

ChairDean

Academic Affairs

2/07Form UCI-AP-92