ࡱ> GIF 5bjbjVV z,<<5 ddLr't#|!"!! '''''''(+'"0z!""','$$$" '$"'$$&&09"F&'B'0r'&, , # ,& ,&$!""$&":"!!!''$ !!!r'"""" ,!!!!!!!!!d m: NORTH CAROLINA OFFICE OF STATE PERSONNEL REQUEST FOR APPROVAL OF SECONDARY EMPLOYMENT Policy The employment responsibilities to the State are primary for any employee working full-time; any other employment in which that person chooses to engage is secondary. An employee shall have approval from the agency head before engaging in any secondary employment. The purpose of this approval procedure is to determine that the secondary employment does not have an adverse effect on the primary employment and does not create a conflict of interest. These provisions for secondary employment apply to all employment not covered by the policy on Dual Employment. Secondary employment shall not be permitted when it would:  SYMBOL 183 \f "Symbol" \s 10 \h  create either directly or indirectly a conflict of interest with the primary employment, or  SYMBOL 183 \f "Symbol" \s 10 \h  impair in any way the employees ability to perform all expected duties, to make decisions and carry out in an objective fashion the responsibilities of the employees position. Approval for secondary employment may be withdrawn at any time if it is determined that secondary employment has an adverse impact on primary employment.  Employee Information Department Division  Employee  ClassificationSecondary Employer  Nature of employers business and description of duties to be performed   (If additional space is needed, continue on the reverse side.) Work Schedule (days/times of work): Employee Certification I understand: the policy governing secondary employment. My secondary employment will not have any impact on and will not create any possibility of conflict with my primary employment. that failure to provide accurate information regarding my secondary employment approval request or to follow all policies regarding secondary employment may be considered unacceptable personal conduct which could subject me to discipline up to and including dismissal. that secondary employment information is public and may be disclosed to third parties. Employee Signature  Date  Approval SignaturesApproved: Yes FORMCHECKBOX  No FORMCHECKBOX  Immediate Supervisor Date Approved: Yes FORMCHECKBOX  No FORMCHECKBOX  Division Director (if applicable)Date Approved: Yes FORMCHECKBOX  No FORMCHECKBOX  Agency Head (or designee)Date Approved: Yes FORMCHECKBOX  No FORMCHECKBOX  State Personnel Director  (if required)Date  f Z [ | }   3 4 5 6  ڮڢzzzzlezzz\ha%5CJ\ ha%5\jha%UmHnHu$jha%5CJU\mHnHuha%5CJ\ha%CJOJQJ^Jha%CJOJQJ^J0jha%5CJOJQJU\^JmHnHu%jha%5CJOJQJU\^Jha%5CJOJQJ\^Jha%5>*CJ\ha%5CJ\ha%$2_f Z 0 1  $If &dP p@ dh$^a$$ & Fh^h`a$$a$dhdh      $Ifqkd$$Ifl0H$ t064 la 3 5 ~  iiiiiiiii%d&d'dOPQ $dNqkd$$Ifl0H$ t064 la %&'*+-.<=>@ASڸڭڸڢڑڸچڸ{j;ha%Ujha%U jha%5U\mHnHujha%Ujha%Ujha%U ha%5\jha%UmHnHu ha%>*ha% ha%CJ$jha%5CJU\mHnHuha%5CJ\0 "N$If & F%d'dOQ!$ & Fh%d'dOQ^h`a$$%d'dOQa$$$d%d'dNOQa$ *]kd$$IflU$h%064 la$IfpkdR$$Ifl~0 $064 laRkd$$IflrG $s@c064 la$If +ASdklvwRkd$$IflrG $s@c064 la$If STcdekvwz{+,-35нвЧМj} ha%Uj ha%Uj\ha%Ujha%Ujha%Uha% jha%5U\mHnHu ha%5\ ha%CJjha%UmHnHu3Rkd$$IflrG $s@c064 la$If ,345RPkd $$IflrG $s@c064 la$Ifx&P+p,p-p.p1h/R / =!"#$`% 4567$$If!vh55#v:V l t065/ / 4$$If!vh55#v:V l t065/ / 4$$If!vh55#v#v:V l~0655/ / / 4$$If!vh5h%#vh%:V lU065h%/ 4tDeCheck1tDeCheck27$$If!vh5s5@555c#vs#v@#v#v#vc:V l065s5@555c/ / / / /  / / 4tDeCheck1tDeCheck27$$If!vh5s5@555c#vs#v@#v#v#vc:V l065s5@555c/ / / / / / / 4tDeCheck1tDeCheck27$$If!vh5s5@555c#vs#v@#v#v#vc:V l065s5@555c/ / / / / / / 4tDeCheck1tDeCheck27$$If!vh5s5@555c#vs#v@#v#v#vc:V l065s5@555c/ /  / / / /  / 4^ 2 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH @`@ NormalCJ_HaJmH sH tH @  Heading 1L$$d%d&d'd@&NOPQ 5>*CJ\T@T  Heading 3$dh@&5>*CJOJQJ\^JDA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List 4T@4 Block TextaJJOJ Bullet Text 2hE^h`EaJHP@H Body Text 2$a$CJOJQJ^J6>@"6 Title$a$ 5CJ\HJ@2H Subtitle$a$5CJOJQJ\^J8B@B8 Body Text 5CJ\Q@R Body Text 3F$d%d&d'dNOPQ 5CJ\PK![Content_Types].xmlj0Eжr(΢Iw},-j4 wP-t#bΙ{UTU^hd}㨫)*1P' ^W0)T9<l#$yi};~@(Hu* Dנz/0ǰ $ X3aZ,D0j~3߶b~i>3\`?/[G\!-Rk.sԻ..a濭?PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!Ptheme/theme/theme1.xmlYOo6w toc'vuر-MniP@I}úama[إ4:lЯGRX^6؊>$ !)O^rC$y@/yH*񄴽)޵߻UDb`}"qۋJחX^)I`nEp)liV[]1M<OP6r=zgbIguSebORD۫qu gZo~ٺlAplxpT0+[}`jzAV2Fi@qv֬5\|ʜ̭NleXdsjcs7f W+Ն7`g ȘJj|h(KD- dXiJ؇(x$( :;˹! 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