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Instructions:
1. Review Employee Data and your Extra Service Appointment and Compensation Offer.
2. Complete the Acceptance Section.
3. If you agree with the Offer, insert your signature at the end of this page.
4. Submit this form.
5. A copy of your signed offer contract and further instructions will be sent to your email address.
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EMPLOYEE DATA
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EXTRA SERVICE APPOINTMENT AND COMPENSATION OFFER
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Must be between 1 and 2 digits. Currently Entered: 0 digits.
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OFFER OF TEMPORARY EXTRA SERVICE
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Indicate whether you accept or decline this offer of Temporary Extra Service: *
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You can also email this form separately to the SUNY Brockport Office of Human Resources, hrdept@brockport.edu
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My signature below affirms the following statements:
(1) I accept the foregoing appointment as offered by the State University of New York College at Brockport.
(2) If I am employed at another SUNY or State Agency, I agree to complete in full the forms applicable to my appointment, i.e., a dual employment form, UP-8, or UP-6 form; plus forms I-9, W4, IT-2109 and a retirement information form.
(3) I understand that failure to comply with completion of forms will result in delayed payment. If only one payment is requested, that payment can only be made after the work is completed.
(4) The hours worked will be outside my normal work schedule or normal obligation to my department. If I must be absent from my regular duties in order to carry out the extra service, I will adjust my work schedule to make up missed hours within the same work week.
(5) I have discussed this temporary extra service with my primary supervisor.
rev. 05/22/2024
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ORIGINATION DETAILS - OFFICE USE ONLY
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