Fill and Sign the Request for Dual Employment 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 appointment 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: