OHRM-Multiple Position Report Form - Updated April 2016
Page 1 of 3
THE CITY UNIVERSITY OF NEW YORK
This form must be completed by all full-time faculty, including full-time substitutes, in the Fall and Spring semesters.
- Please read the Statement of Policy on Multiple Positions, prior to completing this form and consult with the College Labor
Designee, if you have any questions regarding the Policy.
- This form must be completed, and the necessary approvals secured, before the faculty member assumes a multiple position
assignment and must be updated, whenever changes in commitments occur during the semester.
If more space is needed, please attach additional sheets using the same format.
Name
MULTIPLE POSITION REPORT FOR FULL-TIME FACULTY
Title/Tenure Status
Department
Date
Semester
Certification by Faculty Member (Complete Part A or Part B)
Part A: I am aware of the Multiple Position regulations governing
activities in addition to my regular full-time employment at
I certify that I have no compensated or uncompensated employment, consultative or other work, grant-funded or otherwise , in addition to
my regular full-time employment at the above college. I understand that the failure to complete this form fully and accurately could subject
me to various penalties, up to and including termination of employment, following any applicable disciplinary proceedings.
Date
Part B: I am aware of the Multiple Position regulations governing
activities in addition to my regular full-time employment at
In addition to my regular full-time assignment at the College, I have supplementary employment, consultative or other work for extra
compensation (including grant-funded activities), within CUNY for which complete information follows.
(If you check this statement, complete Section B. 1.)
I certify that (check all applicable statements):
In addition to my regular full-time assignment at the College, I have supplementary compensated or uncompensated employment,
consultative or other work for extra compensation (including grant-funded activities), outside of CUNY for which complete information
follows. (If you check this statement, complete Section B. 2.)
My activities are within the limits set by the Multiple Position regulations.
My activities are above the limits set by the Multiple Position regulations and a waiver to permit activities within CUNY has been approved
by the Office of Human Resources Management. (Note: Waivers are not applicable for Section B.2.)
Date
I certify that I have fully and accurately disclosed information in Section B. 1 and B. 2, which includes all compensated and uncompensated
employment, consultative or other work, grant-funded or otherwise, within and outside CUNY, in addition to my full-time employment at
the College.
I understand that the failure to complete this form fully and accurately could subject me to various penalties, up to and including
termination of employment, following any applicable disciplinary proceedings.
If Part A is completed: No further action is required of the college
Signature
College
College
College
Signature
B. 1. CUNY - Current Semester (Only report compensated activities that are not part of your regular full-time position).
* Source of compensation may include tax-levy, Research Foundation or other college non-tax levy entities.
Add additional pages, if necessary.
Department
Course #
Course Title
Hours/Weekly
From Date
To Date
TEACHING (Include activities in the Winter Session with Fall semester activities)
NON TEACHING (Include activities in the Winter Session with Fall semester activities)
OHRM-Multiple Position Report Form - Updated April 2016
Page 2 of 3
Hours/Semester
Nature of Work
Compensated
Uncompensated
To Date
From Date
No. of hours/week
Tel.:
Zip Code
State
City
Address
Employer/Institution/Organization
B. 2. Compensated and Uncompensated Employment, Consultative or Other Work Outside of CUNY - Current Semester
Add additional pages, if necessary.
Hours/Semester
To Date
From Date
Hours/Weekly
Course Title
Course #
Department
Hours/Semester
To Date
From Date
Hours/Weekly
Description of Assignment
Department
Hours/Semester
To Date
From Date
Hours/Weekly
Description of Assignment
Department
OTHER (Include activities in the Winter Session with Fall semester activities)
Hours/Weekly
Hours/Semester
To Date
From Date
Description of Assignment
Department
College
College
College
College
College
OHRM-Multiple Position Report Form - Updated April 2016
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I do not recommend approval of the hours reported in Section B. 1.
Department Chairperson Approval
Date
Name
President/Designee Action:
Approved
Date
Other Action /Comments
The Department Personnel and Budget Committee does not recommend approval of the activities
listed in Section B.1
The Department Personnel and Budget Committee recommends approval of the activities listed in
Section B. 1
Date of P & B Meeting
Section B 1: Approvals should follow campus practice
I certify that the hours reported in Section B. 1 are above the limits set by the University's Multiple Position Policy. I recommend approval,
subject to approval by the President / Designee and OHRM. (An overload waiver request must be submitted to OHRM)
I certify that the hours reported in Section B. 1 are within the limits set by the University's Multiple Position Policy. I recommend approval.
Section B.1: Within CUNY
Section B. 2: Outside CUNY
Approved
Date
Name
I do not recommend approval of the activities and hours reported in Section B. 2.
I certify that the activities and hours reported in Section B. 2 are within the limits set by the University's Multiple Position Policy.
I recommend approval. (Limited to an average of one day a week, or its equivalent over the course of the academic year).
Department Chairperson Approval
The Department Personnel and Budget Committee does not recommend approval of the activities
listed in Section B.2
The Department Personnel and Budget Committee recommends approval of the activities listed in
Section B. 2
Date of P & B Meeting
Section B 2: Department P & B Approval
If consistent with campus practice:
Signature
Signature
Signature of President or Designee
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