(For Faculty Use)

Eastern Michigan University
Report Of Supplemental Employment

_______ SUMMER  _______ FALL  _______ WINTER  _______ SPRING      20_____

NAME: ___________________________    	DEPARTMENT: _____________________

RANK/CLASSIFICATION: ___________________  COLLEGE: __________________

1.	Briefly describe the nature of the work you will be doing.
_____________________________________________________________________________________________________________________________________________________________________________________________________________________

2.	For whom will the work be done? (Provide the name and address of the firm, agency,
etc. Please indicate if self-employed)
_____________________________________________________________________________________________________________________________________________________________________________________________________________________

3.	What are the beginning and ending dates of the employment/activity?
	_______________________________________________________________________

4.	Estimated total number of hours required during the period specified in #3.
_______________________________________________________________________

Faculty Member:   		_____________________________ 	Date: ____________

Department Head/Director: _____________________________ 	Date: ____________

Dean:	          	         		_____________________________	Date: ____________

AVP for Academic HR:  	_____________________________	Date: ____________

Notes: (1)	This form is required by the EMU‑AAUP Faculty Contract and is to be completed by the faculty member prior to undertaking supplemental employment. When completed, the copy is presented to the department head. The form is then forwarded to the Dean and the AVP for Academic HR for their signatures. Signed copies are returned to the dean, department head and the faculty member.

   (2)	A revised report is to be filed by the faculty member whenever a significant change occurs in his or her supplemental employment during the period of this report, or at least every semester.

SEF
July 2008	Official Form for Reporting Supplemental Employment