Request for External Secondary Employment Form

RequestforApproval

OfExternal SecondaryEmployment

Employee Name: Click here to enter text.Department: Click here to enter text.

Date of Request:Click here to enter text. ☐New Request ☐Request for Continuation

• Full-timefacultymembers areexpectedtobeavailableforinstruction,studentadvisement, committeework,andother professional obligationsinherentintheroleoftheinstructor. Eveningandweekendinstructionmayalsoberequiredtosatisfytheregularworkloadorspecific programneeds. Schedule deviationsmust beapprovedbytheVicePresidentofthedivision.
• Specific hours and days of operation are established for each Division and Department in the institution based upon the area of service and function. Inorderto meet theneedsofourstudentsandsupporttheoperationsoftheCollege, eveningandweekendhoursmayberequiredtosatisfy theregularworkload.Deviations fromanestablished schedulemust follow the Alternative Work Schedule Procedures for Faculty and Staff.

Name of external secondary employer: Click here to enter text.

Nature of external employer’s business and description of duties to be performed: Click here to enter text.

External secondary employment work schedule: Click here to enter text.

EMPLOYEE CERTIFICATION

IcertifythatIhavereadandunderstandthepolicy/proceduresgoverningexternal secondaryemployment.

• Iunderstandthatpermission toengageinexternal secondaryemploymentmayberevokedatanytimeif,intheopinionofthe College,suchemploymenthampersmy jobperformanceorcreatesaconflictofinterest.
• Iwillreportanychangesinexternal secondaryemploymentstatusastheyoccur bycompletinganewRequestforApprovalof External SecondaryEmploymentformandsubmittingittomy immediate supervisor. For example, if your secondary employment involves teaching at another institution and you have received approval to teach one course, you must complete a new Request for Approval form to teach any additional courses or perform other secondary employment duties.
• Failuretoprovideaccurateinformationregardingmy requestforexternal secondaryemploymentapprovalortofollowallpolicies/proceduresregardingexternal secondaryemploymentmayresultindisciplinaryactionand/or dismissal, depending on the College’s interpretation of the situation.

Employee’s SignatureDate

Supervisor Review - Required

☐The external secondary employment listed above does not conflict with the employee’s primary employment with the College and is approved.

☐The request is denied because Click here to enter text.

Supervisor’s Name: Click here to enter text.

Supervisor’s Signature: ______Date: ______

Next Level Review - Required

☐The external secondary employment listed above does not conflict with the employee’s primary employment with the College and is approved.

☐The request is denied because Click here to enter text.

Next Level Reviewer’s Name: Click here to enter text.

Next Level Reviewer’s Signature: ______Date: ______

Senior Administrator’s Review - Required

☐The external secondary employment listed above does not conflict with the employee’s primary employment with the College and is approved.

☐The request is denied because Click here to enter text.

Senior Administrator’s Name: Click here to enter text.

Senior Administrator’s Signature: ______Date: ______

President’s Review–External Secondary Employment Request form will be sent to the President if there is a concern the proposed external secondary employment may create a conflict of interest or interfere with the employee’s ability to perform all expected duties.

☐The external secondary employment listed above does not conflict with the employee’s primary employment with the College and is approved.

☐The request is denied because Click here to enter text.

President’s Name: Click here to enter text.

President’s Signature: ______Date: ______

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