Request for Outside Employment
The work of the Village will take precedence over other occupational interests of employees. All outside employment for salaried, wages, or commission and all self- employment must be reported to the employee’s Supervisor, who in turn will report to the Human Resources Director for approval by the Village Manager. Conflicting or unreported outside employment will be grounds for disciplinary action up to and including dismissal.
I,
request to work at
in the capacity or occupation of
Usual hours when outside employment is performed: Number of hours per week involved in this outside employment:
I understand that this additional job must not interfere with, nor take priority over my duties to the Village of Pinehurst. I further understand that I am responsible for reporting any change in the status of my outside employment that may occur PRIOR to the commencement of any outside employment
Employee Signature:
Date:
Recommend Not Recommend Recommend Not Recommend Recommend Not Recommend Recommend Not Recommend
Supervisor Signature:
Date:
Dept Director Signature:
Date:
HR Signature:
Date:
Village Manager Signature:
Date:
Human Resources Department 395 Magnolia Rd. - Pinehurst, North Carolina 28374 (910) 295-1900 - Fax (910) 295-4434 - www.v opnc .org Page 1 of 1
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