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Run: Off-Duty Employment (Secondary Employment) Request and Tracking Form

Track off-duty and secondary employment requests in one place, with schedule, location, duty, and risk details captured before approval.

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Requester Information

Requester Name (required)

Employee ID (required)

Rank or Position (required)

Division or Unit (required)

Immediate Supervisor (required)

Secondary Employment Details

Outside Employer or Organization Name (required)

Employer Contact Name

Employer Contact Phone

Type of Off-Duty Work (required)

Work Description (required)

Briefly describe the duties, equipment used, and whether the work involves public contact or enforcement-related activity.

Requested Schedule and Location

Request Type (required)

Start Date (required)

End Date

Days of Week

Start Time (required)

End Time (required)

Work Location (required)

Provide the primary address or location name. Include multiple locations if the assignment moves during the shift.

Duty, Equipment, and Risk Review

Will the assignment involve carrying a firearm? (required)

Will a uniform, badge, or department identification be used? (required)

Will a personal or agency vehicle be used? (required)

Does the work include any law enforcement-related duties? (required)

Additional Risk or Conflict Details

Compliance Acknowledgment and Approval Tracking

I acknowledge that I will not begin or continue off-duty employment until approval is granted and that I will comply with all department rules, conflict-of-interest restrictions, and reporting requirements. (required)

Yes No N/A

Employee Signature (required)

Submission Date (required)

Review Status

Approved Hours per Week

Approval Notes or Restrictions

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Email (required)

Your name (optional)

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