Request For Formal Leave Of Absence Form - California State University Fullerton Page 13
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REQUEST FOR
ADDITIONAL EMPLOYMENT
Name:
College:
Department:
Date:
Faculty's Comments addressing how additional employment affects the approved leave, and how the leave project
will be accomplished if applicable (attach copy of approved leave proposal).
Name of organization where
additional employment is sought:
Is additional employment with pay?
If yes, amount of remuneration:
Yes
No
List the specific activities for which you will be paid.
If teaching where will you teach? What courses will you teach? How many courses will you teach? Other activities not previously listed:
Amount of time per week:
Name of Supervisor:
Telephone number of
Supervisor (with area code):
Is tenure another institution involved?
Yes
No
List all other information that may be pertinent below (attach additional page if necessary); i.e. will employment
potentially affect any existing contracts, grants, or agreements with the University or its affiliates.
Date:
Faculty Signature:
Chair's comments (attach additional pages if more space is needed)
Recommend?
Date:
Chair's Signature (forward form to Dean):
Yes
No
Dean's comments (attach additional pages if more space is needed)
Recommend?
Date:
Dean's Signature (forward form to Human Resources - CP-700):
Yes
No
Provost's comments (attach additional pages if more space is needed)
Recommend?
Date:
Provist's Signature:
Yes
No
Guidelines for Sabbaticals can be found at
Guidelines for Difference-In-Pay Leaves can be found at
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