Procedure No. 803.1 - Supplement 1
Area: Human Resources

ATLANTIC CAPE COMMUNITY COLLEGE
OUTSIDE EMPLOYMENT FORM
REPORTING YEAR 20____-20____

EMPLOYEE NAME_________________________      SSN#________________________
POSITION TITLE_____________________________________________________
DO YOU CURRENTLY HOLD OUTSIDE EMPLOYMENT?   YES______  NO______
IF YES NAME OF PART-TIME EMPLOYER_________________________________________
ADDRESS____________________________________________________________
TYPE OF PART-TIME WORK TO BE PERFORMED_____________________________
___________________________________________________________________
LICENSES/OTHER GOVERNMENTAL AUTHORIZATION NECESSARY TO PERFORM
THE PLANNED OUTSIDE EMPLOYMENT_____________________________________
___________________________________________________________________
DATES/HOURS THE PLANNED CONTINUING OUTSIDE EMPLOYMENT WILL BE
PERFORMED_________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
__________________________________________________________________
EMPLOYEE SIGNATURE____________________________     DATE___________
SUPERVISING DEAN
OR EXECUTIVE DIRECTOR_________________________     DATE___________
                                                              
EXECUTIVE DIRECTOR

HUMAN RESOURCES_______________________________     DATE___________
                                                             
HR/wc4/00

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