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REPORT OF EXTERNAL EMPLOYMENT FOR CLASSIFIED STAFF (City University of New York)

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Rev. 7/16/20 External Employment for Classified Staff 1
REPORT OF EXTERNAL EMPLOYMENT FOR CLASSIFIED STAFF
Employee/Candidate: Please complete sections A-D regarding your CUNY employment and external employment,
both fulltime and part-time. Carefully read the attestation in section E and sign the bottom. Once it has been
completed and signed, please submit this to the Human Resources Department of the CUNY college at which you
are primarily employed or to which you have applied.
All information on this form is subject to verification. Please be advised that you are required to resubmit this form
with updates if there are any changes to your external employment.
Conflicts which arise unexpectedly over work hours may be resolved by the College’s Director of Human
Resources in favor of the University.
A. EMPLOYEE INFORMATION
Employee Name: ________________________________________________ Date Completed: ______________
B. CUNY Employment
CUNY Primary Position
Title: _________________________________________________________________________________________
College: ______________________________________ Department: ________________________________
Regular Work Schedule: _________________________ Hours per Week: _____________________________
Date of Appointment: __________________________
CUNY Secondary Position
Title: _________________________________________________________________________________________
College: ______________________________________ Department: ________________________________
Regular Work Schedule: _________________________ Hours per Week: _____________________________
Date of Appointment: __________________________
Rev. 7/16/20 External Employment for Classified Staff 2
C. EXTERNAL EMPLOYMENT
Employer: _____________________________________________________________________________________
Address: ______________________________________________________________________________________
Telephone & Fax Numbers: _______________________________________________________________________
Job Title: ______________________________________ Department: ________________________________
Supervisor Name & Title: _________________________________________________________________________
Regular Work Schedule: _________________________ Hours per Week: _____________________________
Date of Appointment: __________________________
D. NO EXTERNAL EMPLOYMENT
I have no external employment. I understand that if I plan to obtain external employment, I must contact
the HR Department of my school and submit an updated “Report of External Employment for Classified
Staff” form BEFORE I begin external employment.
E. EMPLOYEE ATTESTATION
By my signature below, I declare and affirm that the information submitted above is true and complete. I
acknowledge that my full-time position at CUNY is my primary employment. I understand that any
misrepresentation or material omission of facts in this form shall be a sufficient basis for ending further
consideration of my application, or, in the event I have already been hired, shall constitute sufficient cause for
disciplinary action, which may result in a penalty up to and including termination of employment.
Signature: _____________________________________________ Date: ________________________
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Rev. 7/16/20 External Employment for Classified Staff 3
SECTIONS E & F & G ARE FOR OFFICE USE ONLY
F. SUPERVISOR/DEPARTMENT HEAD APPROVAL
Approve: I have reviewed this employee's CUNY employment and his/her completed External Employment
form and have determined that there is no conflict of interest between the two positions and that the
situation is in compliance with CUNY's policy regarding external employment.
Do Not Approve: I have reviewed this employee's CUNY employment and his/her completed External
Employment form and have determined that this situation is NOT in compliance with CUNY's policy regarding
external employment for the following reason(s):
There is a conflict of interest between the two positions.
There is an overlap in scheduled working hours.
There is not adequate time allocated for travel between the positions.
Comments: ____________________________________________________________________________________
Signature: ________________________________________________ Date: ________________________
Name (printed): ____________________________________________ Title: ________________________
G. HUMAN RESOURCES DIRECTOR APPROVAL
Approve: I have reviewed this employee's CUNY employment and his/her completed External Employment
form and have determined that there is no conflict of interest between the two positions and that the
situation is in compliance with CUNY's policy regarding external employment.
Do Not Approve: I have reviewed this employee's CUNY employment and his/her completed External
Employment form and have determined that this situation is NOT in compliance with CUNY's policy regarding
external employment for the following reason(s):
There is a conflict of interest between the two positions
There is an overlap in scheduled work hours
There is not adequate time allocated for travel between the positions
Comments: ____________________________________________________________________________________
Signature: ________________________________________________ Date: ________________________
Name (printed): ____________________________________________ Title: ________________________
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Rev. 7/16/20 External Employment for Classified Staff 4
H. PRESIDENTIAL APPROVAL FOR EXTERNAL FULL-TIME POSITIONS
Approve: I have reviewed this employee's CUNY employment and his/her completed External Employment
form and have determined that there is no conflict of interest between the two full-time positions and that
the situation is in compliance with CUNY's policy regarding external employment.
Do Not Approve: I have reviewed this employee's CUNY employment and his/her completed External
Employment form and have determined that this situation is NOT in compliance with CUNY's policy regarding
external employment for the following reason(s):
There is a conflict of interest between the two positions
There is an overlap in scheduled work hours
There is not adequate time allocated for travel between the positions
Comments: ____________________________________________________________________________________
Signature: ________________________________________________ Date: ________________________
Name (printed): ____________________________________________ Title: ________________________
Please return to the HR Director.
Retain original document in employee file.
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REPORT OF EXTERNAL EMPLOYMENT FOR CLASSIFIED STAFF (City University of New York)

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Completed 2 February 2022

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