DUAL EMPLOYMENT/EXTRA SERVICE APPROVAL FORM

AC 1588 (Rev. 3/13)
STATE OF NEW YORK
OFFICE OF THE STATE COMPTROLLER
BUREAU OF STATE PAYROLL SERVICES
DUAL EMPLOYMENT/EXTRA SERVICE APPROVAL FORM
REQUEST FOR APPROVAL TO SERVE WITH ANOTHER STATE AGENCY
SEND APPROVALS TO: Office of the State Comptroller, Bureau of State Payroll Services
TO BE COMPLETED BY EMPLOYEE
PRESENT EMPLOYMENT:
Name........................................................................................ Agency (where employed)..........................................................
Title ......................................................................................... Dept. ID.......................................................................................
Email Address.......................................................................... NYS EMPLID..............................................................................
Primary Employment Work Schedule (Optional):
Mon__________ Tues__________ Wed__________ Thurs__________ Fri__________ Sat__________ Sun__________
ADDITIONAL EMPLOYMENT REQUEST:
I request approval to render additional service to the......................................................................................................................
(Name of Agency) (Dept. ID)
at ..............................................................., for the period from.............................................through..............................................
for the purpose of.............................................................................................................................................................................
(Brief Description of Work to be Performed)
.........................................................................................................................................................................................................
Dual Employment/Extra Service Employment Work Schedule (Optional):
Mon__________ Tues__________ Wed__________ Thurs__________ Fri__________ Sat__________ Sun__________
…… I do not render additional service in any other agency.
…… I render additional service in another agency.
The name of that agency is
..........................................................................................
Dept. ID.....................................
This requested additional service will not interfere with my regular duties.
Date......................................................................Signature..............................................................................................
ACTION BY HEAD OF DEPARTMENT OR AGENCY WHERE REGULARLY EMPLOYED
*Approved.................................................................. £
Disapproved (Do not forward to Office of the State Comptroller)
£.
Approved through......................................................
£
Approved with the following limitations:......................................................................................................................................
£
.........................................................................................................................................................................................................
This additional service will not interfere with the
performance of the employee’s regular duties.
Name of Agency Department Head
Date................................................................... By................................................................................
*ALL APPROVALS WITHOUT A LIMITING DATE WILL EXPIRE
CLOSE OF BUSINESS ON MARCH 31st OF THE FISCAL YEAR.
(Signature & Title of Authorized Designee)
A Signed Original of this Form Must Be Forwarded to the Bureau of State Payroll Services Before Payments Can Be Processed.