Form Op 175w - Request For Waiver Of Restriction On Per Session Employment - Nyc Department Of Education - New York
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1Chancellor’s Regulation C-175
Attachment No. 2
Page 1 of 1
REQUEST FOR WAIVER OF RESTRICTION ON PER SESSION EMPLOYMENT (OP-175W)
Directions: The appropriate Per Session Supervisor must sign and submit this form to request a waiver of the
restrictions on per session employment, in accordance with Chancellor’s Regulation C-175. Per Session employment
may not exceed 500 hours (with a maximum of 270 hours in a school psychologist and/or school social worker
(SP/ SW) position) in a per session year unless prior approval is received from the Division of Human Resources.
Failure to obtain a valid waiver may result in the withholding of payment.
Waiver is requested for: _________________________ ____________________
____________
(Last Name)
(First Name)
(MI)
Email Address: __________________________________
File # ___________________________
To be completed by the Per Session Activity Supervisor:
The applicant has been selected for the position of: __________________________________________
Budget Code _____
District ____ Quick Code __________ Line # _________ Job ID _________
Location of Per Session Activity: (School/Office)
_________________________________________________
Per Session Program Supervisor/ Supt.: _______________________________ Phone: (______)___________
Email Address: __________________________________
Please enter the number of hours above the hour maximum that you are requesting this waiver for:
___________ number of hours over 500 limit OR ___________ number of hours over 270 SP/ SW limit
Between what dates and how widely was the position advertised (School/ District or Borough/ Citywide)?
(Attach copy of advertisement)
_________________________________________________________________________________________
Number of applications received for this position: ______________
Are there other applicants for whom a waiver would not be needed? _______
If so, indicate why these applicants were not selected:
_________________________________________________________________________________________
_________________________________________________________________________________________
Please explain why this is the only applicant that is qualified for the additional work in this activity:
_________________________________________________________________________________________
_________________________________________________________________________________________
Declaration of Per Session Supervisor: I certify that this position was advertised and selected in accordance with
the regulations governing per session employment and the current Collective Bargaining Agreement, and that this
waiver is needed to staff the position appropriately. Per Session employees have been notified that they are not
permitted to exceed these hours unless prior written approval has been received from the appropriate ISC or Division
of Human Resources.
____________________________________________
_________________________
Signature of Per Session Supervisor
Date
Submission Information: Submit this form and a copy of the employee’s APPLICATION FOR PER SESSION
EMPLOYMENT AND CLAIM FOR RETENTION RIGHTS (Form OP-175) along with the advertisement announcing this
position to appropriate office for review:
SCHOOL/ DISTRICT/ BOROUGH Positions:
Your Integrated Service Center’s HR Partner or Children First
Network’s HR Director. For SW/ SP positions, please submit to your ISC’s Deputy Executive Director, Special
Education or your CFN HR Director.
CENTRAL Positions: Division of Human Resources – 65 Court Street (Rm. 801), Brooklyn, NY 11201.
For Principal Per Session Activities Only - Principals must submit a per session waiver request to their
Superintendent using the current WEB online per session request system in FAMIS.
FOR ISC OR HUMAN RESOURCES ACTION (BASED ON LOCATION OF PER SESSION ACTIVITY)
To Applicant/Program Supervisor: Your request for a waiver of the restriction noted above for per session year
_____________ has been
Approved ________
Disapproved ________
________________________________________
_________________________
ISC or
Division of Human Resources
Date
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