Human Resources
Outside Activities Request Form
Name:
Date:
Title:
Department:
Pursuant to University System of Georgia Outside Activities and Conflict of Interest policies, I hereby request approval to
engage in outside employment/ activity as described below:
Nature of employment/activity:
Time required for employment/ activity:
I understand that an Albany State University employee shall not engage in any occupation, pursuit, or endeavor which
will interfere with the regular and punctual discharge of official duties. I further understand that all full-time faculty,
administrators, and other professional staff members employed by Albany State University are expected to give full
professional effort to their assignments of teaching, research, and service.
Professional employees are encouraged to participate in professional activity that does not interfere with the regular
and punctual discharge of official duties provided the activity meets one of the following criteria:
1. It is a means of personal professional development;
2. It serves the community, state or nation; or,
3. It is consistent with the objectives of the institution.
For all activities, except single occasion activities, the employee shall report in writing the proposed arrangements and
secure supervisory approval prior to engaging in the activities. All Albany State University employees must annually
recertify all Outside Employment/ Activity. I understand that failure to comply could result in disciplinary action up to
and including termination of employment.
________________________________________ ______________________
Employee Signature Date
ADMINISTRATIVE ACTION _____________ Request Approved ___________ Request Denied
Comments or Special Conditions
________________________________________ _____________________________________
Supervisor Signature & Date HR Signature & Date
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