Ucf-Human Resources-Dual Compensation Request Form
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1Request for UCF Dual Compensation
University of Central Florida - Human Resources
Records & Payroll Services
Form must be completed with all signatures and attached to ePAF to HR Records.
NAME OF EMPLOYEE
EMPLOYEE ID #
UCF PRIMARY EMPLOYING DEPARTMENT/DIVISION
UCF SECONDARY EMPLOYING DEPARTMENT/DIVISION
UCF PRIMARY DEPARTMENT/DIVISION
UCF SECONDARY DEPARTMENT/DIVISION
BEGIN DATE
END DATE
POSITION
PERIOD OF
NUMBER/TITLE
EMPLOYMENT
RATE
RATE OF PAY
RATE
TOTAL PAYMENT
(NOTE HOURLY OR ANNUAL)
DAILY IN / OUT
WEEKLY
DAILY IN / OUT (specify time)
WEEKLY
WORK SCHEDULE
(WEEKLY TOTAL)
□
□
FUNDING DEPARTMENT #
FUNDING DEPARTMENT #
C&G**
C&G*
APPROPRIATION PAID FROM
□
E&G
FULL TIME EQUIVALENCY (FTE)
*Primary department should check if employee is C&G for primary employment
** All C&G funding requires review by Office of Research & Commercialization Compliance prior to submittal to Human Resources.
PROVIDE DETAILS OF DUTIES TO BE PERFORMED IN SECONDARY EMPLOYMENT and EXPLANATION/JUSTIFICATION OF
EMPLOYMENT. (Attach additional sheets if necessary).
SECONDARY EMPLOYER Authorized Signature _________________________________________________ Date ___________________________
Print Name__________________________________________________________
The hours and rate of pay indicated for the second position are agreeable. This certifies the hours indicated in ‘work schedule’ above are
accurate, outside of my primary position’s working hours, and do not interfere with my primary position.
EMPLOYEE Signature ________________________________________________________________________ Date ___________________________
Print Name________________________________________________________________________
This employee has my approval to perform the additional duties indicated above for the secondary employer. These duties will not be
performed during the employee’s regular working hours in their primary position, will not involve a conflict of interest with the
employee’s regular duties in their primary position, and will not involve the use of any university space, personnel, equipment or supplies
furnished by their primary employer.
PRIMARY EMPLOYER Authorized Signature _____________________________________________________ Date __________________________
Print Name______________________________________________________________
DEAN/DIRECTOR OF PRIMARY DEPARTMENT Authorized Signature _____________________________________________________________
Must be on Authorized Signature List
______________________________________
_____________
Print Name
Date
O
R
C
: Signature ________________________________________________ Date __________________________
FFICE OF
ESEARCH AND
OMPLIANCE
A
CKNOWLEDGEMENT
Pint Name_____________________________________________________
This section must be completed for grants.
Questions involving ePAFs may be directed to
Records@ucf.edu
Revised 06/2016 MK
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