REQUEST FOR OUTSIDE EMPLOYMENT
Name: Date:
Department: Title:
As directed by Policy 1.10 Outside Employment, I hereby request approval to engage in outside employment as
described below:
Nature of Employment:
Time required for Employment:
I understand that City policy forbids me from engaging in any form of outside employment or business opportunity, for
myself or another employer, which would conflict or interfere with my job at the City of Stephenville, while on City time,
or using City equipment or materials. I understand that in order to engage in outside employment, I must receive
approval from my supervisor and Department Director in advance of performing such outside employment, and that the
approval may be withdrawn at any time. I also understand and agree that my outside employment must be suspended
if my work status is FMLA leave, sick leave, workers’ compensation leave, or restricted duty.
Employee Signature Date
Supervisor Signature Date
__Request Denied
DEPARTMENT DIRECTOR ACTION
__Request Approved
Comments or Special Conditions:
Department Director Signature Date
Forward completed form to the Human Resources Department
Appendix E
Form 1
click to sign
signature
click to edit
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click to sign
signature
click to edit
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click to sign
signature
click to edit
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