Outside Employment Form
Applicant details
DOCUMENT 5
Surname: | Given Names: Classification: | Branch/State: Section: | Location: Manager: | Phone No:
Outside employment details
Is the work paid, unpaid or voluntary?
Paid [ ] Unpaid [ ] Voluntary [ ]
Outside employment role description, duties and additional hours
Please provide a brief description of the outside employment including roles, duties and hours per week.
To what extent will your outside employment limit your availability for overtime or additional hours?
Is your outside employment relevant to confidential or particular information which you require in the course of your duties?
Yes [ ] No [ ]
If Yes, please give details
Last updated 16 May 2017
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Describe any real or perceived conflict of interest which may impact on your official duties in NDIA.
Applicant’s signature
Signature: Date:
Manager to complete
Do you consider the outside employment will place the applicant in a real or perceived conflict of interest with their National Disability Insurance Agency official duties?
- Yes
- No
If Yes, please comment
The conflict of interest should be declared and managed using the Conflict of Interest - Disclosure Form.
Do you consider the outside employment will adversely impact on the applicant’s performance of their official duties?
- Yes
- No
If Yes, please comment
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Do you recommend approval of this application?
Yes No
If No, please comment
Manager’s details
| Name: | Signature: |
|---|---|
| Position: | Phone: |
Delegate to complete (minimum EL2 Director)
Does the application meet the requirements of the Outside Employment advice on the intranet?
Yes No
Approved Not Approved
Provide reasons if Not Approved
Delegate’s details
| Name: | Signature: |
|---|---|
| Position: | Phone: |
| Employee advised in writing | Date
| Name | Signature
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