Request For Extra Compensation For Faculty & Staf Form - Human Resources And Employee Development
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1Human Resources and Employee Development
Request for Extra Compensa on for Faculty & Staff
By signing you are verifying that all BOR criteria are met and are in compliance with the procedures and policy as indicated below.
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___________________
Date Submi ed
__________________________________________________
____________________________________________________
Employee’s Name
Last 4 digits of employee’s SS# or VSU ID #
Home Department Informa on
Reques ng Department Informa on
__________________________________________________
__________________________________________________
Employee’s Title
Reques ng Department
__________________________________________________
__________________________________________________
Employee’s Department
School/College/Division
__________________________________________________
__________________________________________________
Employee’s School/college/division
Funding Source for Extra Compensa on
No. of hours this request ______________________________
__________________________________________________
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/
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Funding Source Account Number
Dates from/to _________ _______/__________________
Is this Grant Funded? (Yes/No)
Yes
No
Amount $___________________________________________
Please provide a brief descrip on of work to be performed and explain why this addi onal compensa on is necessary:
I will perform the du es as described above. The number of hours above reflect the work me required
___________________________________________________
for the services to be performed outside my normal work day or while I am on annual leave.
Employee’s Signature (required)
Date
Extra Compensation (8.3.12.4)
Approved by:
(Once Work is Performed)
Research, Saturday Classes, & Off-Campus Education that meet below criteria:
In accordance with USG Policy 8.3.12.4, extra compensa on may be
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paid for par cipa ng in appropriate University instruc onal, research,
_______________________________________________________________
or service ac vi es when all four of the following condi ons are met:
Home Department Head (or VP if appropriate)
Date
The work is carried in addi on to a normal work load
/
/
No qualified person is available to carry the work as part of his/
_______________________________________________________________
her normal load
Reques ng Department Head
Date
/
/
The work produces sufficient income to be self-suppor ng
_______________________________________________________________
The addi onal du es are not so heavy as to interfere with the
Reques ng Dean/Director
Date
performance of regular du es
When extra compensa on is paid, it shall be no greater than compen‐
sa on paid for performance of the employee’s normal du es.
Extra Compensation (5.3.2)
All others duties provided they met the below criteria:
Per USG Business Procedures Sec on 5.3.2 ; all 3 criteria must be met :
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Task must be outside of employee’s regular department.
________________________________________________________
Academic Affairs (Required)
This form is signed by appropriate departmental heads.
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Employee must meet at least one of the criteria below: Chaplain,
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Fireman, Den st, Cer fied Interpreter for Deaf Persons, Regis-
_______________________________________________________________
tered Nurse, LPN, Psychologist, teacher/Instructor of evening
HR Approval
Date
course or program, Professional holding doctoral or masters
degree; part– me employee
Revised 10/22/14
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