Form OA1

The University of Oxford

Application for approval to undertake outside work
(including consultancies and directorships)(see Notes 1 and 2)

APPLICANTS SHOULD COMPLETE THIS FORM AND SEEK THE RELEVANT APPROVALS PRIOR TO ENTERING INTO FORMAL COMMITMENTS

The completed form should be held on the department’s files. A copy should be provided to the applicant.

The information supplied on this form will be processed in accordance with the Data Protection Act 1998 and the University’s Data Protection Policy. The information given here will not be used for commercial purposes.

1.Applicant

Name
Faculty or Department

2. Nature of outside appointment or activityTick One

Consultancy - through Oxford University Consulting (OUC), or
Consultancy - private/independent (that is, not through OUC), or
Non-executive Directorship, or
Executive Directorship, or
Visiting Professorship that involves giving more than 8 lectures per year, or
Services agreement (providing services to an external party, other than as a consultant), or
Other (please describe)

3.External Organisation benefiting from outside appointment or activity (including spin-off companies and University subsidiaries)

Name
Address
Brief description of the organisation
(its purpose and activities)

4.Period of appointment or activity

Date of commencement
End Date
Number of days per annum required under the appointment (see Note 3)
Is the arrangement renewable? (see Note 4) / YES or NO

5.External Sponsorship

If your salary is funded from external sources, or if are you the named Principal Investigator or Co-Investigator on outside-funded grants or contracts, the terms and conditions of such sponsorship may require you first to seek permission of the sponsor to accept the outside commitment or may otherwise restrict or limit your ability to undertake outside commitments (see Note 5).

Is there any such sponsor? Yes No

If yes,

(a) Name of sponsor(s): ______


(b) Do they require you to seek their permission to undertake the activity you are proposing in this application?

(c) If yes, did they grant permission? Yes No

Please briefly explain: ______

6.Other outside work activities/appointments

Please outline below details of all other outside work activities which you have permission to undertake or might expect to apply to undertake during the period covered by the current application.

Organisation / Nature of Activity Nature of Activity / Days required per annum

7Data related to the HE-BCI Survey (see Note 6) (**OPTIONAL**)

Please complete only if you are seeking approval to undertake a private consultancy[1]

HEFCE funding to the University is influenced by the data we can provide about consulting activity via the annual higher education-business and community interaction (HE-BCI) survey. To maximise the funding to Oxford - funding which is allocated by the Planning and Resource Allocation Committee to support a wide variety of academic and academic-support activities - we need to report on three (3) aspects of consulting activities. The data you are asked to provide below will be used only to report in aggregate to HEFCE. Nostaff names or other individual identifiers are reported to HEFCE. The data will not be used by the University for any other purpose.

(a) Please estimate the total payment to you: ______

OR if you would prefer, please indicate the total payment ‘band’ (please tick one)

<£1k
£1k<£5k
£5k<£10k
£10k<$15K
£15k<£20K
>£20K

(b) Is the organisation a Small-to-Medium Sized Enterprise (SME)?Yes/No

Small and medium-sized enterprises (SMEs) are defined by the European Commission as having fewer than 250 employees, and an annual turnover of not exceeding 50 million euros and/or an annual balance sheet of not exceeding 43 million euros

(c) Is the organisation situated in the South East (SEEDA) Region? Yes/No

The South East Region covers Berkshire, Buckinghamshire, Hampshire, the Isle of Wight, Kent, Oxfordshire, Surrey and East and West Sussex, as defined by the South East Development Agency (

8Declaration

In regard to the current application

1.I am satisfied that the proposed arrangement does not create a conflict of interest with my work at the University, and undertake to comply with the University’s policy on Conflict of Interest(see Note 7). / YES / NO (see Note 8)
2.I am satisfied that the provisions of the proposed arrangement safeguard the University’s rights in intellectual property which may arise during the course of my work for the University and the confidentiality of know-how generated in that context (see Note 9). / YES / NO
3.I am satisfied that the proposed arrangement is permitted under the terms of any external research grant or contract in which I am involved (and, where required, I have obtained the necessary permissions from the research sponsor/collaborator)(see Note 5). / YES / NO
/ N/A
4.I shall abide by University policy on the Regulations Relating to the use of Information Technology Facilities (see Note 10). / YES / NO
5.I shall not make use of any University facilities without obtaining the approval of the Head of the Department for arrangements for such use (including reimbursement at the appropriate economic rate) (see Financial Regulations 8.4). / YES / NO
6.I shall neither use a University address in connection with the outside commitment for which permission is being sought, nor hold myself out as doing the work in the course of my university employment. / YES / NO
/ N/A

And if the application relates to consulting work to be done privately/independently (and not through Oxford University Consulting)

7.I (or the company which will be the legal contractor) hold appropriate insurance. / YES / NO
8.I (or the company which will be the legal contractor) will indemnify the University against any financial risk. / YES / NO
9.I will make it clear to the client that the University is not involved in the consultancy agreement in any way (ensuring that their clients are aware that they are acting in a private capacity). / YES / NO

Signature: ______Date: ______

Name: ______

9.Approval by the Head of Department (or equivalent) (see Note 11)

I am satisfied

(i) with the terms of the application as set out above

(ii) that if the applicant is supported by or involved in a research project supported by external funding, he/she has referred to the relevant conditions of the grant/contract and has obtained approval from the external sponsor(s) in relation to this outside commitment, as necessary
(If not applicable, please write N/A here: ______)

(iii) that this outside commitment will not hinder the applicant from fully carrying out the prescribed duties of his or her university post

(If not applicable, please write N/A here: ______)

AND EITHER

(iv) in accordance with the University’s Conflict of Interest Policy, to the best of my knowledge the undertaking of this commitment will not lead to any conflict of interest

OR

(v) the arrangements proposed by the applicant address any identified conflicts satisfactorily.

Signature: ______Date: ______

Name: ______

10.Approval by the Conflict of Interest Committee

If approval for the holding of an executive directorship is sought, the approval of the Conflict of Interest Committee is also required (see Note 1).

Please submit this form in hard copy or by emailto the Secretary of the Conflict of Interest Committee, Council Secretariat, University Offices, Wellington Square, email: unsigned form can be accepted if the form is submitted with an email from the Head of Department (or equivalent) sent from a University of Oxford email account indicating approval.
Notes on the Completion of Form O1A

1.University Policy is set out in ‘Council Regulations 5 of 2004: Regulations for the holding of outside appointments and the conduct of outside work’ and the ‘Guidance Notes for the holding of outside appointments and the conduct of outside work’ – see

2.The University’s Consultancy Policy and Procedures, approved by Personnel Committee, are outlined at

3.Please note that the total number of days to be devoted each calendar year to all outside appointments and activities should not normally exceed 30 days.

4.In respect to outside commitments that are expected to be ‘rolling’ arrangements, permission must be sought and renewed each 12 months.

5.Please seek advice from Research Services if you are in any doubt.

6.See

7.See

8.If no, please attach a letter of explanation, including how you propose to manage any Conflict of Interest.

9.If no, please attach a letter of explanation.

10.See

11.The person who signs the forms should be:

  • the Head of Department or Faculty Board Chairman; or
  • the Head of Division if the applicant is a Head of Department, or the application is for a total of more than 30 days per year; or
  • the line manager of the senior officer making the application (where applicable). For the avoidance of doubt,the application should be made to the Vice-Chancellor in respect of each of the Pro-Vice-Chancellors with portfolio, the Heads of Division, the Registrar and Bodley’s Librarian. In the case of the Vice-Chancellor, he or she should submit an application to the Chancellor.
  • the person at the next higher level of authority if the Head of Department (or equivalent) has an interest in the appointment or activity.

1

[1] Data on consultancies through OUC will be sourced directly