Office of Human Resources 216 Bray Hall 1 Forestry Drive Syracuse, NY 13210 Phone: 315-470-6611 www.esf.edu
Approval Request for:
Extra Service/Also Receives/Summer Session
(SUNY-ESF employees—payment for services rendered to SUNY-ESF)
______ Extra Service (services rendered outside current department/position)
______ Also Receives (overload or additional duties within current department/position)
______ Summer Session (For SUNY-ESF Academic Year Employees only)
Employee Name: _____________________________________________________________________________________________________________________
Additional Service Dates: Start Date: _____________________________ End Date: ___________________________
Current Title: _________________________________________________________________________________________
Unit/Department: _____________________________________________________________________________________________________________________
Description of Services to be Provided: ___________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Schedule of Services (days of week/hours): ________________________________________________________________________________________________
Account #: ________________________ Additional Services Compensation: $_______________________ _______Biweekly _______Total Compensation
Type of Service: ______ Instructional or _____Non-Instructional
Signature of Unit Head/Chair (requesting additional services):______________________________________________________ Date: ________________________
For Academic Affairs Only:
Signature of Assistant VP for Academic Finance:_____________________________________________________________ Date: ________________________
For All: ________________________________________________ _____________________________________________ Date: ________________________
Vice President/Chief of Staff (print name) Vice President/Chief of Staff (signature)
_______ Approved _______Not Approved _____ Approved with the following limitations:
Limitations:_________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Presidents Signature: ________________________________________________________________________________ Date: ___________________________
I accept this additional service and certify that it will not interfere with my professional obligation to the college. If category is Extra Service, I agree to complete
Certification of Obligation form (next page) monthly.
Employee Signature: _________________________________________________________________________________ Date: ___________________________
Additional Service Title: ____________________________________________ Copies: ___ Original in HR File ___ Employee Copy ___Payroll
Line # ____________________ ____ Unit Head/Department Chair that is requesting additional services
Current Salary: _______________________________ ____Current Unit Head/Department Chair (if different than above)
Completed by Unit Head/Department Chair of Additional Service (prior to commencement of additional service)
Presidents Approval
Employees Signature
Human Resources Office
_______ Recommended _______Not Recommended _____ Recommended with the following limitations:
Limitations: _________________________________________________________________________________________________________________________
___________________________________________________________________________________________________________________________________
Current Unit Head/Department Chair Signature: _____________________________________________________________ Date: _________________________
Completed by Current Unit Head/Department Chair (if not the one requesting additional services)
Upon completion -
Return to 216 Bray Hall
EXTRA SERVICE CERTIFICATION:
To be completed monthly for the Category of Extra Service by a
SUNY-ESF employee at SUNY-ESF.
Employee Name: ___________________________________________________________
Extra Service Unit/Department: ___________________________________________________________
Month Ending: ___________________________________________________________
______ I certify I met my obligation during the month.
______ I certify I met my obligation during the month with the exception of the following:
__________________________________________________________________
__________________________________________________________________
Employee Signature: ________________________________________________ Date: _______________
Extra Service Unit Head/Chair Signature: _______________________________ Date: _______________
Return Completed form to:
SUNY-ESF Human Resources Office
216 Bray Hall
315-470-6611
Revised 4.29.19
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