TO BE COMPLETED BY EMPLOYEE
PRESENT EMPLOYMENT:
Name ....................................................................................... Agency (where employed) .........................................................
Title ........................................................................................ Dept. ID ......................................................................................
Email Address ......................................................................... NYS EMPLID .............................................................................
Primary Employment Work Schedule (Optional):
Mon__________ Tues__________ Wed__________ Thurs__________ Fri__________ Sat__________ Sun__________
ADDITIONAL EMPLOYMENT REQUEST:
I request approval to render additional service to the .....................................................................................................................
at .............................................................., for the period from ............................................through .............................................
for the purpose of ............................................................................................................................................................................
........................................................................................................................................................................................................
Dual Employment/Extra Service Employment Work Schedule (Optional):
Mon__________ Tues__________ Wed__________ Thurs__________ Fri__________ Sat__________ Sun__________
I do not render additional service in any other agency.
I render additional service in another agency. The name of that agency is
......................................................................................... Dept. ID ....................................
This requested additional service will not interfere with my regular duties.
Date...................................................................... Signature .............................................................................................
ACTION BY HEAD OF DEPARTMENT OR AGENCY WHERE REGULARLY EMPLOYED
* Approved .................................................................

Disapproved (Do not forward to Ofce of the State Comptroller)

Approved through .....................................................

Approved with the following limitations: .....................................................................................................................................
........................................................................................................................................................................................................
This additional service will not interfere with the
performance of the employee’s regular duties.
Name of Agency Department Head
Date................................................................... By ...............................................................................
* ALL APPROVALS WITHOUT A LIMITING DATE WILL EXPIRE
CLOSE OF BUSINESS ON MARCH 31st OF THE FISCAL YEAR.
(Signature & Title of Authorized Designee)
A Signed Original of this Form Must Be Forwarded to the Bureau of State Payroll Services Before Payments Can Be Processed.
AC 1588 (Rev. 3/13)
(Brief Description of Work to be Performed)
STATE OF NEW YORK
OFFICE OF THE STATE COMPTROLLER
BUREAU OF STATE PAYROLL SERVICES
DUAL EMPLOYMENT/EXTRA SERVICE APPROVAL FORM
REQUEST FOR APPROVAL TO SERVE WITH ANOTHER STATE AGENCY
SEND APPROVALS TO: Ofce of the State Comptroller, Bureau of State Payroll Services
(Name of Agency) (Dept. ID)
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