Fill and Sign the Add Job Division of Human Resources Ampamp Organizational Form

{Insert Name of Company} Human Resources REQUEST FOR DUAL EMPLOYMENT Please complete Section I below and submit to Human Resources before a salary commitment is made to the employee, and prior to the dual employment occurring. SECTION I Employee’s Name: ID#: FULL-TIME Department Information REQUESTING Department Information Dept Name: Dept Name: Dept Code: Dept Code: Title: Title: Title Code: Title Code: Grade/Step: Grade/Step: Rate: Rate: Dept Contact: Ext. Dept Contact: Ext. Approximate Duration of Dual Employment : To: If the full-time position is exempt, please state the time to be worked in the dual employment appointme nt on line ‘A’ as a fixed percentage. If the full-time position is non-exempt, please state the maximum time to be worked as a number of hours per day, week or month on line ‘B.’ A. Exempt: % of full time per month B. Non-Exempt: Hours Per: Day Week Month Reason for Dual Employment: Description of Duties: Note: All time worked over and above 40 hours in a standard workweek by a non-exempt employee must be compensated at the appropriate overtime rate by the department(s) in which the time was actually worked . x (Print) Full-Time Dept. Supervisor Name Approval Signature Date x (Print) Requesting Dept. Supervisor Name Approval Signature Date SECTION II – To be completed by Human Resources Approved Title: Eligible for Premium OT?: YES NO  If position is exempt, fixed monthly amount to be effected (Rate x Percentage to be worked): $ /month If position is non-exempt, hourly rate to be effected: $ /hour Decision: Approved Denied Compensation Consultant: Date: / / Notes: