Fillable SHIPPENSBURG UNIVERSITY REQUEST FOR ADDITIONAL COMPENSATION THROUGH THE (Shippensburg University of Pennsylvania)

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SHIPPENSBURG UNIVERSITY REQUEST FOR ADDITIONAL COMPENSATION THROUGH THE (Shippensburg University of Pennsylvania)

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REVISED 11/25/02
SHIPPENSBURG UNIVERSITY
REQUEST FOR ADDITIONAL COMPENSATION – THROUGH THE INSTITUTE FOR PUBLIC SERVICE
TITLE
FUNDS CENTER
PAY TO:
DATES SERVICES WERE RENDERED:
From:
TO:
COMPENSATION REQUESTED:
$
BARGAINING UNIT
CHECK ONE
( )
State Paid Benefits Included in Compensation
Charge to
( )
State Paid Benefits Not Included in Compensation,
Cost Center
JUSTIFICATION:
These services have not interfered with the employee’s primary duties, and this
dual employment is not in violation of the Code of Ethics of the State Adverse
Interest Act.
1. Requested by
Date
Employee
My signature certifies that the reported dates and times of employment are
accurate and true.
2. Requested by Date
Director
3. Approved by Date
Dean (Employee’s)
4. Approved by Date
Director, Institute for Public Service
5. Funds Available Date
Fiscal Administrator
6. Approved by Date
V.P. for Academic Affairs
-----------------------------------------------------------------------------------
PAYROLL DATA:
Date Paid:
VT #
Cost Center Charged:
Gross:
SS#
W/C:
M/H:
Life:
Ret:
H/W:
Other:
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SHIPPENSBURG UNIVERSITY REQUEST FOR ADDITIONAL COMPENSATION THROUGH THE (Shippensburg University of Pennsylvania)

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Completed 26 August 2020

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