Request For Approval Of Outside Employment Form Page 3
ADVERTISEMENT
1
2
3REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
Current Employment Information
Name of Employee:____________________________________
Title: _______________________________________________
Department: _________________________________________
Direct Supervisor: _____________________________________
Describe Current Job Duties: ____________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Requested Outside Employment Information
Potential Employer's Name: _____________________________________________________________
Contact Person: ______________________________________________________________________
Address: ____________________________________________________________________________
Telephone: ___________________________________ e-mail: ________________________________
Anticipated Start Date: __________________________ Estimated End Date: _____________________
Daily Time Schedule: ___________________________ Estimated Hours per Month: _______________
Amount and form of compensation: _______________________________________________________
___________________________________________________________________________________
Describe requested Job Duties/Scope of Work: ______________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
Describe your efforts to ensure that the requested employment does not conflict, or appear to conflict, with
your Present County Employment: ________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
I hereby affirm that the requested outside employment described above is not in conflict, nor does it
appear to conflict with my employment with Monroe County and that no outside work will occur during
County time or using county resources of any type. Further, I recognize that my Monroe County
employment is my primary employment and my outside employment will not interfere with the complete
execution of my duties for Monroe County, and that this approval is subject to revocation at any time and
the limitations outlined in the County’s Duel Employment Policy as it may be amended from time to time.
Employee Signature:
___________________________________ Date: ________________________
Recommended
Not Recommended
______________________________________________
Department Head Signature
Date
Recommended
Not Recommended
______________________________________________
Human Resources Director Signature
Date
Approved
Not Approved
______________________________________________
Monroe County Executive Signature
Date
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business