TCC/HRM/DUAL Effective: 02/01/2020
Dual Employment Request Form
Request to Hold Multiple TCC positions
Section A.
Employee Name: Phone Number: Date Requested:
Section B.
CURRENT PRIMARY EMPLOYMENT REQUESTED SECONDARY
EMPLOYMENT
Position Title:
Department:
Division/Office/Section:
Supervisor:
Overtime Eligibility:
Regular Rate of Pay:
Work Schedule:
Period of Employment:
Budget Information:
Request: (
Check as appropriate
)
Current Primary
Employment Assignment:
Requested Secondary
Employment Assignment:
Employee Agreement and Waiver: This is to certify that the hours indicated above are accurate, outside my normal working hours
in my primary employment and do not interfere with my primary employment. I accept that this secondary employment outside
of my primary employment or in excess of one established position requires College approval which may be denied. Further, I
understand that the approval of this employment may be withdrawn or terminated with two (2) weeks prior notice for cause or
without cause at the discretion of the College. I also accept that I may establish employment rights in only one position and that I
may not receive benefits in excess of one full-time established position from all combined employment. Employees whose
primary job is non-exempt (or overtime eligible) are not permitted to work in another position within the College.
Employee Name (Print Name) (Signature) Date
Yes
No Yes
No
Executive/Administrative
Adjunct
Managerial /Professional
OPS
Faculty
Professional Service Contract
Classified Staff
Executive/Administrative
Adjunct
Managerial /Professional
OPS
Faculty
Professional Service Contract
Classified Staff
Cost Center
Cost Center
From:
To:
From:
To
:
Must be submitted and approved annually by September 1
TCC/HRM/DUAL Effective: 02/01/2020
The Primary Employing Department Must Complete This Section:
The additional duties for the secondary employer as indicated above will not be performed during the employee’s working hours
with this department, will not involve a conflict of interest with the employee’s regular assigned duties in this department, and will
not involve the use of any space, personnel, equipment or supplies furnished by this department.
Furthe
r, the requested dual employment will not impede the mission, goals and/or service provided by the employee’s primary
employment assignment and will not exceed the approved hours as stated above.
Recommended Action Taken:
Primary Supervisor (Print Name) (Signature) Date
Secondary Employer Agreement (Must be completed only if recommending for hire):
The justification for the
dual employment request and a copy of the employees position description/primary duties are attached.
The requesting employee has the specific skills, training and abilities for this immediate need, and hiring in a dual employment
capacity at this time is in the best interest of the College.
Further, as the secondary employer, I agree it is my responsibility to notify the employee, HR, and the primary supervisor of any
changes to hours, job duties, etc. and ensuring that the assignment will not exceed the approved hours stated above.
Recommended Action Taken:
Secondary Supervisor (Print Name) (Signature) Date
Executive Team Member (Print Name) (Signature) Date
Human Resource Department Must Complete This Section:
HR Department must review dual employment requests to ensure that the dual employment will not interfere with the employee’s ability and
availability to perform his/her primary assigned duties with the College; the dual employment does not have the appearance of a conflict of
interest; the dual employment does not have overtime liability; and the dual employment does not result in total hours worked for TCC to be 25
per week or greater.
Action Taken:
Human Resource Director (Print Name) (Signature) Date
Approved
Disapproved
Approved
Disapproved
Executive Team Member Must Complete This Section:
Recommended Action Taken:
Approved
Disapproved
Approved
Disapproved
Primary TCC Position is:
Exempt from
overtime
Non-exempt
from overtime
HR Notes and Comments:
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