Appendix 1 | Declaration of outside employment

Declaration of Outside Employment Form

Employee Information:

• Name:

• Employee ID:

• Department:

• Position:

Details of Outside Employment:

• Name of Outside Employer:

• Nature of Outside Employment:

• Number of Hours per Week:

• Start Date:

• Description of Duties:

Conflict of Interest:

• Do you believe the outside employment will create a conflict of interest with your current role? (Yes/No)

• If yes, please provide details:

Approval Request:

I hereby request approval from the employer to engage in outside employment as detailed above. I confirm that the outside employment will not hinder my performance or duties at my current job.