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Any CPS employee who has secondary employment at the me of hire or any me during his or her employment with
CPS must submit this approval form to the Ethics Advisor. Secondary employment means any non-CPS employment for
remuneraon. Approvers are listed on page 2 of this form. However, an INTERSESSION SECONDARY EMPLOYMENT
NOTIFICATION FORM should be filled out instead of this form by an employee who works for CPS less than 52 weeks per
year and has secondary employment only during intersession.
This form may be completed electronically, but must be printed out and signed by the employee and the employee’s
approver prior to submission.
SECONDARY EMPLOYMENT APPROVAL FORM
CPS EMPLOYMENT INFORMATION
Complete these boxes with informaon relang only to CPS employment.
NAME WORK ADDRESS
WORK PHONE CELL OR HOME PHONE
JOB TITLE SCHOOL NAME/AREA OFFICE OR DEPARTMENT
DESCRIPTION OF DUTIES
WORK SCHEDULE: Please specify start and end mes for each day (for example 8am - 5pm).
Mon __________ Tues __________ Wed __________ Thurs __________ Fri __________ Sat __________ Sun __________
Variable/Other Hours:
Please describe. __
SECONDARY EMPLOYMENT INFORMATION (Including Ownership/Partnership in any Business)
Complete these boxes with informaon relang only to secondary employment.
NAME OF EMPLOYER OR BUSINESS TYPE OF BUSINESS
ADDRESS OF EMPLOYER OR BUSINESS Is this address where you perform your dues? YES NO
If NO, Please pr
ovide the address where you perform your dues:
NAME OF SUPERVISOR OR SELF-EMPLOYED TITLE OF SUPERVISOR IF NOT SELF-EMPLOYED
DESCRIPTION OF DUTIES
WORK SCHEDULE: Please specify start and end mes for each day (for example 6pm - 8pm).
Mon __________ Tues __________ Wed __________ Thurs __________ Fri __________ Sat __________ Sun __________
Variable/Other Hours:
Please describe. _______________________________________________________________________________
