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INSTRUCTIONS & IMPORTANT REMINDERS FOR COMPLETING THE FORM

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INSTRUCTIONS & IMPORTANT REMINDERS FOR COMPLETING THE FORM CT-HR-25
May 2017
Review General Letter 204 and the “Dual Employment Processing” Job Aid before completing.
An employee has just one FLSA Status. For the purpose of dual employment, it is imperative
the employee’s FLSA Status has been determined in accordance with the US DOL FLSA
Regulations. Questions concerning the FLSA Status of a position are to be directed to DAS
SHRM – Classification & Pay Unit.
In accordance with the “Approvals Procedure” in General Letter 204, DAS SHRM – HR
Business Rules & Central Audit Unit must review and approve the Form CT-HR-25 (“CT-HR-
25”) when the FLSA Status is Nonexempt or when the hours of the assignments are the same.
This review will be expedited when (all) agencies are able to certify via the CT-HR-25 the
employee will never exceed 40 combined hours per week.
The employee must not begin work in the new assignment until all necessary approvals
are on file*.
The agency hiring a current state employee initiates the completion of the CT-HR-25 (when the
employee intends to remain employed in his/her current job beyond the start date in the new
assignment). Refer to the Core-CT HRMS “Dual Employment Processing” Job Aid.
• Enter the date the CT-HR-25 is completed, the name of employee, the employee’s (Empl)
ID, and the FLSA Status of the employee.
• Next to the appropriate Core-CT Record, each agency specifies the following:
o Agency name and assignment work location
o Job title and/or major duties of the position
Check the box if the DAS class specification reflects the primary duties of the
employee’s assignment.
When the job title is Faculty, Instructor, Lecturer, Substitute Teacher or Graduate
Assistant where the primary duty of the assignment is teaching, the title alone may
be listed.
For all other assignments, list the title and major duties to be performed by the
employee. (Attach a separate sheet of paper for additional duties, as necessary.)
o For Higher Education only:
Complete the course information for higher education teaching assignments.
Enter load hours; combined load hours cannot result in eligibility for additional
benefits
Indicate when an employee is teaching an online class
o The start date of the assignment
Higher Education teaching assignments only: This date may or may not be the
start of the semester. (Do not enter the semester start date unless the employee
is actually scheduled to teach on that date. Rather, enter the actual date the
employee is first scheduled to work.)
o Indicate if the employee is working in an occasional or sporadic work schedule
For online and occasional or sporadic assignments: after discussing the hours of
work for each assignment with the employee and ensuring the dual assignment is
appropriate relative to the employee’s other assignment(s), indicate the schedule
varies and will not conflict with other assignments.
APPROVAL PROCESS
Once (all) agencies involved with the dual or multiple employment have provided the required
information pertaining to each assignment, the CT-HR-25 must be reviewed and signed by the
employee and the Agency Head or designee at each agency.
Agencies may approve this form when the appointment(s) are made in accordance with General
Letter 204 and the employee’s FLSA Status has been determined to be Exempt. Approvals from
Fiscal Managers (at each agency involved with the dual or multiple assignment) and from DAS
SHRM are required if there is any chance of overtime.
* Exceptions may be made when all jobs involve teaching assignments or in an emergent
situation when the employee’s FLSA Status is Exempt and when it is imperative for coverage,
i.e., Substitute Teacher. In such situations, the fully executed form must be on file within seven
(7) business days from the first day the employee worked in the assignment.
Statewide Human Resources Management
Dual Employment Request Form
Form #: CT-HR-25
Revised: 5/2017
The hiring agency initiates a Dual Employment Request (Form CT-HR-25) when hiring a current state employee
into another state assignment (and the employee intends to continue working in his/her existing assignment). This
form is required in accordance with C.G.S. Section 5-208a and General Letter 204. See Instructions on Page 1.
Core-CT
Record #
Agency and
Assignment
Work Location
Job title or Major Duties
Check if duties reflected on
DAS class specification (see
Instructions for more information)
Official Job Title
or
Course ID
(Higher Education)
Higher Ed
Load Hrs.
Anticipated 1
st
Day
of work in (new)
0
1
2
3
Attach additional information including major duties and Core-CT Records, as necessary.
Today’s Date
Name of Employee
Empl ID
FLSA Status
Core-CT
Record #
Online
Course?
Occasional
or
Sporadic?
Work
Schedule
varies; no
conflict
Course/
Assignment
Schedule
Workweek: Seven consecutive days beginning on
Friday at 12:01 AM through midnight Thursday
Fri.
Sat.
Sun.
Mon.
Tues.
Wed.
Thur.
0
Start Time:
Unpaid
Break:
End Time:
1
Start Time:
Unpaid
Break:
End Time:
2
Start Time:
Unpaid
Break:
End Time:
3
Start Time:
Unpaid
Break:
End Time:
The employee must read and initial each of the following statements as they apply to the employee’s
dual/multiple employment assignments and acknowledge all information by signing below:
G
ENERAL:
___I have been advised General Letter 204 – Dual Employment is available online and understand I should
address my questions about dual/multiple employment to the Human Resources Office in any of the employing
agencies listed on this form.
___I have reviewed all of the assignments on this form and attest the information presented reflects all of my
current work assignments with the State of Connecticut (including the Judicial and Legislative Branches and
quasi-public agencies where employees are construed to be state employees).
___I have reviewed the work schedule information and confirm there is no time conflict between assignments
or duplication of hours worked in any of the assignments on this form. I understand I am not to perform work
for one assignment while working in another assignment and that I cannot take paid or unpaid leave time from
one assignment in order to travel or perform duties of another assignment.
___I have reviewed the State Ethics Policy, have had an opportunity to raise questions to the Ethics Officer in
my agency, and certify no conflicts of interest exist.
C
OMPENSATION:
___I understand I am ineligible for overtime as my FLSA Status is Exempt
___I understand I am eligible for overtime as my FLSA Status is Nonexempt
___I further understand that I will receive overtime pay for hours actually worked over 40 in a week and
that I should inform Human Resources when I work more than the scheduled hours indicated on this form.
___I understand the overtime rate for hours worked over 40 in a week will vary because it is based on the
number of hours worked in each assignment (“weighted average”). The approximate overtime rate is
calculated at _______ hourly.
Weighted Average Overtime Calculation
a.) Job 1 # Hours x Pay Rate + Job 2 # Hours x Pay Rate = Total Straight-time Pay
b.) Total Straight-time Pay / Total Hours = Weighted Average Regular Rate of Pay
c.) Weighted Average Regular Rate of Pay / 2 = Sub-total
d.) Sub-total from ‘c.’ x Hours over 40 = Total Overtime Amount
Reason: FLSA requires the payment of overtime at time and one half for all hours actually worked over 40
in a week to eligible employees. The hours over 40 have already been paid as straight time by each agency;
now the additional “half” must be added to the straight time already paid, using the weighted average rate.
___I understand this dual/multiple employment assignment is approved until _________ (Maximum length:
either the end of the semester for higher education teaching assignments or up to 12 months for non-higher
education assignments or higher education non-teaching assignments).
___I have been informed the continuation of my eligibility to work in the dual assignment is contingent upon
there being no change to assigned work schedules, job duties or job titles in any of the assignments indicated,
and my future acceptance of an additional assignment(s). I understand that I must immediately inform
Human Resources of any change before it occurs and that implementation of such change will require a new
CT-HR-25. I understand the result of any change in information presented on this CT-HR-25 may be cause for
termination of assignment(s) prior to the aforementioned date.
_______________________________________________________________________________________
Print Employee’s Name Employee’s Signature Date
EMPLOYEE ACKNOWLEDGEMENT
By signing this form, agencies certify the following:
• Duties and responsibilities of both the primary and secondary positions have been reviewed in accordance with
General Letter 204 and by applying the US Department of Labor (US DOL) Fair Labor Standards Act (FLSA)
Tests for exemption to determine overtime liability.
o Following the review of duties, I further certify (check one):
___The employee’s FLSA Status is Exempt; the employee will never incur overtime.
___The employee’s FLSA Status is Nonexempt but the combined hours of all assignments are far
below 40 and will never exceed 40 in a week. Therefore, there is no possibility of the employee
incurring overtime.
___The employee’s FLSA Status is Nonexempt and there is a possibility the combined hours of
all assignments may exceed 40 in a week. Therefore, the employee may incur overtime. A weekly
review of all hours actually worked will be conducted by all agencies. Approval from each Fiscal
Director has been received; DAS approval is required.
___The employee’s FLSA Status is Nonexempt. The employee will definitely work more than 40
combined hours in a week. A weekly review of all hours actually worked will be conducted by all
agencies. Approval from each Fiscal Director has been received; DAS approval is required.
• Duties specified are outside the responsibility of the employee’s principal employment.
• Hours worked are documented accurately and have been reviewed to preclude duplicate payment.
• No conflicts of interest exist between services performed.
If for any reason there is a change in the hours and/or days of work indicated, or if there is a change in the
employee’s job class or dual/multiple assignments, a new CT-HR-25 with the required information will be
completed, reviewed and approved, as appropriate by all agencies, Fiscal Managers and DAS. The new fully
executed CT-HR-25 will be retained for post-audit.
Approvals
Signatures below certify all conditions under C.G.S. Sec. 5-208a, General Letter 204 and FLSA Regulations are
met. A fully executed copy of the CT-HR-25 along with all relevant materials must be retained by each agency
for DAS post-audit purposes.
This assignment is approved through close of business _____________________.
Core-CT Record 0:
___ Yes ___No ___________________________________________________________________________________
Agency Signature of Agency Head/HR Designee Official Job Title Date
___Approval Fiscal Manager: _________________________________________________________________________
Signature Official Job Title Date
Core-CT Record 1:
___ Yes ___No ___________________________________________________________________________________
Agency Signature of Agency Head/HR Designee Official Job Title Date
___Approval Fiscal Manager: _________________________________________________________________________
Signature Official Job Title Date
Core-CT Record 2:
___ Yes ___No ___________________________________________________________________________________
Agency Signature of Agency Head/HR Designee Official Job Title Date
___Approval Fiscal Manager: _________________________________________________________________________
Signature Official Job Title Date
Core-CT Record 3:
___ Yes ___No ___________________________________________________________________________________
Agency Signature of Agency Head/HR Designee Official Job Title Date
___Approval Fiscal Manager: _________________________________________________________________________
Signature Official Job Title Date
___Approval from DAS: _____________________________________________________________________________
Signature Comments, if any Date
EMPLOYING AGENCY’S OR AGENCIES’ CERTIFICATION
DEPARTMENT OF ADMINISTRATIVE SERVICES
450 Columbus Boulevard, Suite 150 I, Haitford, CT 06103
TO : Agency Heads and Agency HR Directors
DATE: May 31, 2017
RE: General Letter No. 204 - Dual Employment (Revised)
PURPOSE
The purpose of this General Letter is to ensure uniform procedures for dual employment assignments
to guarantee compliance with state and federal law.
POLICY
This policy is in accordance with Sec . 5-208a of the Connecticut General Statutes and supersedes
- General Letter 204 Dual Employment dated May 12, 2014 and all earlier memoranda on this subject.
SCOPE
This General Letter applies to all employees except department heads* in the executive branch,
including higher education and quasi-public agencies where employees are construed to be state
employees. Temporary Worker Retirees are covered (all hours worked count toward the 120-day
maximum); employees of the Judicial and Legislative Branches who are engaged in a dual employment
assignment are also covered. For the purpose of this policy, the term "state agency" or "agency" applies
to all of these entities .
REQUIREMENTS
In accordance with Sec. 5-208a of the Connecticut General Statutes, no state employee shall be
compensated for services rendered to more than one state agency (or in more than one position in the
same agency) during a biweekly pay period unless the appointing authority or designee of each agency
approves a dual employment agreement. Agencies are responsible for certifying the dual assignment
will not result in eligibility for additional benefits or overtime and any dual employment assignment that
results in additional benefits or the necessity to pay overtime must be approved in advance by the
Commissioner of Administrative Services through the Statewide Human Resources Management
Division (DAS SHRM) .
RESPONSIBILITIES
Prior to making an offer of employment, agencies must determine whether or not the selected individual
is currently employed by another agency. (Refer to "Scope" section.) When the agency's selection will
result in a dual (or multiple) employment assignment , the hiring agency must contact the current agency
*Section 4-8 of the Connecticut General Statutes restricts a department head ("appointing authority" or "agency head") from accepting
any other employment while serving in the department head assignment.
Page 1 of 5
Affirmative Actio11/Equa/ E111p/oy111e11t Opportunity Employer
directly and complete a thorough review of the individual'·s employment in both _(or all) jobs. (Emphasis
added)
Working directly with the current employing agency, the hiring agency completes the Dual
Employment Request Form (CT-HR-25) to certify that:
• The duties to be performed in the dual employment assignment are outside the responsibility of
the agency of principal employment.
• No conflicts of interest will be created as a result of the dual employment. Agency Ethics
Compliance Officers have been consulted, as appropriate. (Review the statutes and regulations
on this topic.)
• The hours worked in each assignment do not overlap and will not result in duplicate payment,
provided:
o If mandatory overtime is a condition of employment in either assignment, the request must be
denied and
o Travel time must be considered, such that:
• Paid or unpaid leave time cannot be used to travel to or from one assignment to another
or to work in either assignment;
• The employee cannot use flextime or an Alternate Work Schedule if there is an expectation
the employee must be available during hours outside of the approved schedule OR if the
employee's work schedule reverts back to a standard workweek during a holiday week;
and
• The employee cannot use the Voluntary Schedule Reduction Program to work in or travel
to another state job. (This is because although the employee is working a reduced
schedule, benefits, including retirement credit and creditable service, are not diminished
and therefore the employee must account for the hours of a full-time schedule.)
• The approval of the dual employment assignment will not result in the employee becoming eligible
for additional benefits, including but not limited to eligibility for insurance and/or retirement
benefits.
• The combined weekly hours in all positions will not result in overtime. Note: in dual employment
situations, an employee's eligibility for overtime is determined by the US Department of Labor
(US DOL) Fair Labor Standards Act (FLSA).
o An employee has just one FLSA Status, either 'Exempt' (ineligible for overtime) or
'Nonexempt' (eligible for overtime). The FLSA Status is determined by the duties performed
in the Primary job.
o Typically, the Primary job is where the employee works the most hours; an employee may
have only one Primary job.
• When the hours of two assignments are the same, the Primary job is based on hire date. The ·
position where the employee was first hired is the Primary job and unless it is clear the FLSA
Status of both assignments is Exempt, the duties of both positions must be reviewed by DAS
SHRM to determine the employee's FLSA Status. (Emphasis added)
CERTIFICATION PROCEDURES FOR MAKING DUAL EMPLOYMENT APPOINTMENTS
The hiring agency completes the CT-HR-25, certifies the information is accurate , and submits the CT-
HR-25 to the current agency.
• If the employee is or will be employed with more than two agencies, all agencies must review,
complete and approve the CT-HR-25 in order for the dual employment assignment to be valid.
• All agencies are responsible for ensuring the information on the CT-HR-25 is accurate.
Page 2 of 5
Affirmative Aclio11/Eq11al ity Employer Employme11r Opport1111
o If there is. any question as to the Primary job designation , the employee 's FLSA status or
whether the dual assignment will result in additional benefits, the agency questioning the
information should direct the inquiry to DAS SHRM for an official review and response.
o Questions about conflicts of interest are to be directed to the agencies' Ethics Compliance
Officers.
APPROVAL PROCEDURES FOR MAKING DUAL EMPLOYMENT APPOINTM ENTS
This chart illustrates when a dual assignment may be approved by the agencies and when DAS
approval is required:
FLSA Status of
Prima Job
FLSA Status of Secondary Job
Nonexempt same or fewer hours than Prima
Approvals Required
In order for DAS SHRM to consider approving a request that may result in benefit eligibility or the
payment of overtime , agencies must:
• Demonstrate the assignment is unique , specialized and extremely difficult to recruit;
• Document recruitment efforts and results from those efforts, including a copy of the job posting
and selected candidate's application form;
• Complete and submit to DAS SHRM the CT-HR-25 along with the aforementioned information/
materials, upon request.
Under extraordinary circumstances, DAS SHRM may approve a dual employment assignment which
may result in benefit eligibility or may incur overtime . In this case, DAS SHRM will provide both
agencies with the overtime rate. In addition :
• Fiscal managers at both agencies must approve the CT-HR-25 when there is a possibility of
overtime.
• The specific amount and rate of overtime calculated is subject to change based on the number
of hours the employee actually works each week in each assignment.
• Attendance must be reviewed by agencies each week and the amount of overtime must be
calculated manually and on a weekly basis by the agency(s) . Refer to CT-HR-25.
Notes:
The following are critical points and/or considerations:
• An employee who works a 10-month schedule but who is paid over 12 months is not considered
to be dually employed when s/he is actively employed during the intersession in another position
with the State-of Connecticut. However, the dual employment process is to be followed when the
employee accepts more than one additional assignment during the intersession and when the
dates of those additional assignments overlap.
• When the employee will be employed in more than two assignments simultaneously, DAS SHRM
review is required unless the FLSA Status of all of the jobs is Exempt.
Page 3 of 5
Affir111ative Actio11/Eq11 Opport1111ia/ E111ploy111e11/ ty E111ployer
• Some situations meet the US DOL definition of "occasional and sporadic" employment.
Occasional and sporadic employment means "infrequent , irregular, or occurring in scattered
instances" and performing work that is different than the employee's Primary (or other) state
assignment(s) .
In those cases , the hours are not included in the combined hours worked in a
dual assignment. DAS SHRM will determine when this definition applies.
• The Overtime field in thf;l Core-CT Job Data record reflects overtime eligibility in accordance with
the employee's collective bargaining agreement (CBA). The Federal FLSA field in the Core-CT
Job Code Table record reflects either of the following: the default value from the Overtime field
in Job Data or the FLSA value de,ermined by DAS SHRM. The latter may or may not be different
than the Overtime field . When the values of both fields are the same, agencies must conduct a
review of duties to ensure the correct FLSA designation. Values for both fields are: Nonexempt
(eligible for overtime) and No FLSA (Exempt).
• Dual employment requests requiring DAS SHRM approval must be fully executed prior to the
employee working in the dual assignment.
• Dual employment requests that may be approved by agencies (and without DAS SHRM approval)
must be fully executed prior to the employee working in the dual assignment except as follows:
o When all jobs involve teaching assignments or when an emergent situation arises resulting in
an immediate need for coverage and the· employee 's FLSA Status is Exempt,
DAS SHRM will
consider
a CT-HR-25 to be in compliance with this policy provided it is fully executed within
seven (7) business days from the first day the employee worked in the (emergency)
assignment. An example of an emergent situation is
a substitute teacher. (Emphasis added)
Length of AssignmenURenewal
Dual employment requests may be approved for up to 12 months unless any of the assignments are
scheduled by semester or school year.
• When an assignment is the length of a semester , approval expires at the end of the semester .
• When a dual assignment is the length of a school year , approval expires at the end of the school
year.
o If, at any time , the dual employment assignment fails to meet the above-listed criteria, the
assignment must be terminated.
• If there are any changes to the employee's jobs or schedule that involve or create the potential
of an overtime obligation or benefit implication, the agency implementing the change must follow
the procedures for requesting DAS SHRM review and approval of the dual employment
assignment. The changes must be postponed .or the dual employment assignment must be
suspended unless and until a new approval has been granted .
Agencies ' Continuing Obligations
Once the CT-HR-25 is fully executed , agencies have a responsibility to continue to monitor the dual
employment assignment.
• Agencies shall monitor employee dual employment assignments regularly. (Refer to "Other"
section below).
• When there is a possibility of overtime, both agencies must manually review the employee's
attendance in both jobs each week to ensure the proper rate of pay. Refer to the CT-HR-25 for
the "weighted average" overtime calculation.
• The employing agencies shall provide requested documentation or other information to DAS
SHRM in a timely manner.
Page 4 of 5
Affirmative Actio11/Eq11 Opport1111ityal E111p/oyme11/ Emp/oyei·
17-03
POST-AUDIT
It is imperative all agencies involved with a dual employment arrangement comply with this policy,
applicable federal and state law, and the collective bargaining agreements , as appropriate. DAS SHRM
will periodically conduct post-audits of dual employment transactions for employees holding multiple
positions in state service. Agencies must be able to provide fully executed Forms CT-HR-25 upon
request during the post-audit. In addition , DAS SHRM will regularly review Primary/Secondary job
indicators; agencies must promptly provide the requested information and must resolve these issues
upon learning of a problem.
OTHER
Agency Heads, through the agency Human Resources Office or other agency designee , have the
following dual employment-related responsibilities :
• Ensuring all dual employment assignments are made in accordance with this policy.
o Appropriately delegating the assignment of determining FLSA Status of a position to a trained
staff member capable of performing the analysis.
o Regularly monitoring the DUAL_EMPLOYMENT _REPORT for changes in employment that
may impact on dual employment approval, to find dual assignments that are not in
compliance, and to find assignments that are due to expire .
• Ensuring the prompt data entry of all dual employment activity, including terminations and correct
Primary/Secondary job designations.
• Meeting all document retention requirements and
• Responding to all requests for information under the Freedom of Information Act (FOIA) .
Please contact the assigned DAS HR Consultant for any questions regarding this General Letter.
_7/fl~~--,~~J._.G=-)~ - ~ff1
Melody A. Cu~rey
~
Commissioner
Department of Administrative Services
Page 5 of 5
Affirmative Actio11/Eq11al Employme nt Opportunity Employer
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INSTRUCTIONS & IMPORTANT REMINDERS FOR COMPLETING THE FORM

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Completed 25 July 2020

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