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Warning Text %XTableStyleMedium9PivotStyleMedium48dq:F3ffff̙̙3f3fff3f3f33333f33333\`NSheet1kSheet2lSheet38p 44In accordance with regulations established by the Board of Trustees of State Institutions of Higher Learning, I hereby request NAME DEPARTMENT(Or Grant Name)TITLEEmployment Activity is&Explain nature of Employment Activity:KName and address of organization for which work will be done (be specific):8Amount of time devoted to employment activity (explain):Will this employment activity:YesNo+If yes to any of the above, please explain: (Check one)eIf additional space required, please attach a separate sheet and indicate attachment by checking box:I understand that I must take Personal Leave for any time I spend on outside employment during regular work hours. I also understandthat permission to engage in outside employment can be denied or canceled if the outside employment unduly interferes with my workSignature of Employee Date APPROVALS:(1)(2)(3)4(If Employee is paid from Externally Funded Project)(4)(5) AA/EOE/ADAIYESNOCheck Yes or NoIf yes, explain: Supervisor or Director of Unit91gAlcorn employees desiring to engage in outside employment or practice of profession must complete this IMMEDIATE SUPERVISORInside 91Outside 91WDoes the organization referenced above have a relationship with 916Involve the use of Alcorn facilities and/or equipment?!Utilize Alcorn support personnel?$Interfere with normal Alcorn duties?(Utilize Alcorn supplies and commodities?Director of Sponsored ProgramsHuman Resources DirectorVice President of Unit President2Permission to Engage in Outside Employment (05/14):APPLICATION FOR PERMISSION TO ENGAGE IN OUTSIDE EMPLOYMENT`permission to engage in outside employment or practice of profession at 91.^The Board of Trustees of State Institutions of Higher Learning has established that "Institutional members of the faculty and staff are permitted to engage in outside employment, provided permission is first obtained from the executive officer of the institution concerned, and provided further, that the executive officer of the institution concerned shall grant permission to engage in outside employment only after having first determined that said outside employment will interfere in no way with the institutional duties of the individual requesting such permission. In addition, such individual will not engage in a business or profession that would in any manner compete with a similar business or profession over which he/she would have direct supervision, inspection, or purchasing authority within the university or agency, such being a "conflict of interest." In particular, this directive is understood to cover (1) connection with any business enterprise as consultant, owner, partner, officer, director, or agent; or (2) connection with any public office either by election, appointment, or employment.#or that of 91.sform and forward it through the appropriate channels to the President for approval. 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