UP-6 (Rev. 01/11)
II. Action by Chief Administrative Officer
Approved Disapproved
Approved with the following
limitations:
(date) Signature Chief Administrative Officer/Designee
III. Action by System Administration
Approved Disapproved
Approved with the following
limitations:
Office of the Chancellor
by
(date) Signature Director, University-Wide Human
Resources/Designee
Distribution
Chief Administrative Officer Employee Copy System Administration (2 copies)
State University of New York
University-Wide Human Resources
Albany, New York 12246
UP-6 Request for Approval of Extra Service for M/C Employee
C2063-187
INSTRUCTIONS: Part I of this form is to be completed by the employee in an original plus three copies and submitted to the campus's Chie
dministrative Officer for approval prior to commencing extra service. Two copies are then forwarded to the Director, Unive
sity-Wide
Human Resources in System Administration. The campus will retain one copy for its records. After approval is obtained from System
dministration, a copy of the UP-6 will be sent directly to the Office of the State Comptroller with a copy back to the campus. The campus
processing the approved appointment may then effect payment in accordance with the rules for extra service (upon receipt of vouchers) or
concurrent a
ointment.
I. To Be Completed by Employee
Name Last 4-digits of SSN: Campus/Agency
Address Title
Email Address Current Salary
I request approval to render extra service on a part-time full-time
basis to:
Agency:
At: (location of
employment)
For the period from:
Through:
Describe purpose of work:
Total compensation for this additional work will not exceed:
This extra service will not interfere with my normal obligations to the University.
(date) Signature of Requesting Employee
