Work Schedule Disclosure Form printable pdf download

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WORK SCHEDULE DISCLOSURE FORM

Last Name

First

1. University Commitments: List work commitments to be performed during the next six months.

Campus

Appointment

Appointment Title

Course

If Instructional,

Contact Person

& Dept

Period

(Instr, Lectr, etc.)

Number/Title

Cr/ContactDays/Times

Name/Phone, if known

Applications Pending at the University of Hawaii:

List applications which are pending at other

UH departments/campuses (Example: Lecturer Appointment Pending)

Campus

Department/Division

Contact Person (Name/Phone, if known)

Outside (Non-University) Work Commitments and Schedule

a) Briefly describe present employment and geographical location.

b) Describe present weekly work schedule (days and times).

Notes:

Failure to provide us complete information may result in an inaccurate paycheck or a delay in payment.

University of Hawaii Administrative procedures A9.560, Appointment of Lecturers and Cooperating Teachings/Counselors

states that, “...lecturers should not (emphasis added) be appointed for more than the equivalent of 15 semester hours in the

Community Colleges or 12 semester hours at Manoa, Hilo, and West Oahu. Appropriate equivalencies should be developed for

those who may lecture at the Community Colleges and Manoa, Hilo or West Oahu at the same time.

Lecturers employed full-time elsewhere (other than UH employment) should not be appointed for more than six-credit hours per

semester or nine-credit hours during the academic year (the same limits as for full-time University faculty members).”

It is the responsibility of the lecturer to provide complete employment information to the homebase campus to ensure that the

lectureship appointment conforms to established rules, regulations and procedures.

UH Form 22 (rev. 10/06)

_______________________________/_____/_____

j:ohrdocsformsuh form 22.doc

Signature

Date

Work Schedule Disclosure Form