The University of Texas at San Antonio s1

THE UNIVERSITY OF TEXAS AT SAN ANTONIO REQUEST FOR PRIOR APPROVAL OF OUTSIDE EMPLOYMENT/CONSULTATION/ APPOINTMENT/POSITIONS INCLUDING SELF EMPLOYMENT

Title:

Department:

UT EID:

Approval is requested for permission to engage in the following outside employment activity.

Employment Firm, Person or Agency:

Address:

City: State: Zip:

Briefly describe work to be performed:

Amount of time to be spent in outside employment per week:

Proposed employment will begin and continue through

If employment is with state or federal government, please complete:

Compensation to be received is

Explain how holding this office would benefit the State of Texas, or explain that holding the position is required by state or federal law. University equipment may not be used for consulting purposes by any member of the faculty or staff without express approval as outlined below. In unusual cases where a very unique piece of equipment is not otherwise available, such usage may be authorized, assuming availability of the equipment and adequate compensation to the University. In such cases, the faculty or staff member making the request must describe the University equipment to be used and justify its request. In no case, is the rate of compensation to be negotiated by the faculty or staff member. Such negotiations will be between the Business Office of the University and the entity contracting with the faculty or staff member to consult. Negotiations for the use of equipment and rate of compensation will not occur until final approval has been given to the Request for Prior Approval of Outside Employment/Consultation/Appointment/Positions, Including Self Employment.

I acknowledge that I have read and will abide by the Rules and Regulations of the U.T. System Board of Regents, series 30103. There is no conflict between my holding this office or position and my UTSA position.

Signed: Date:

APPROVAL RECOMMENDED BY:

Department/Division Administrator Date Dean/ Other Administrative Official Date

APPROVED BY:

Vice President Date

PRIVACY NOTICE

With a few exceptions, you are entitled to be informed about the information U.T. San Antonio collects about you. Under Sections 552.021 and 552.023 of the Texas Government Code, you are entitled to receive and review this information. Under Section 559.004 of the Texas Government Code, you are entitled to have U.T. San Antonio correct information about you that is held by us and that is incorrect, in accordance with the procedures set forth in the University of Texas System Business Procedures Memorandum 32. The information that U.T. San Antonio collects will be retained and maintained as required by Texas records retention laws (Section 441.180 et seq. of the Texas Government Code) and rules. Different types of information are kept for different periods of time.

Rev. 1-2006 \hr\docs\RequestForPriorApprovalOfOutsideEmployment.doc