Extra Service Offer

Office of Human Resources

Extra Service Request Entry No.
Number of payments
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.
EMPLOYEE DATA
Employee Name Employee Name First Last
Email - Employee
Primary Department
Budget Title
Current Position Type
Employment Classification
Extra Service employee worked at SUNY Brockport within the last three years
Name - Primary Supervisor Name - Primary Supervisor First Last
Notification of Offer decision will be sent to
EXTRA SERVICE APPOINTMENT AND COMPENSATION OFFER
Extra Service work is
Purpose of extra service work:
Extra Service Supervisor is also Primary Supervisor
Extra Service Department
Extra Service School or Unit (Division of Academic Affairs)
Extra Service Division
Name - Extra Service Supervisor Name - Extra Service Supervisor First Last
Notification of Offer decision will be sent to (in Extra Service Department)
Notification of Offer decision will also be sent to (representing Extra Service Department)
Total Stipend:
Number of Payments
Must be between 1 and 2 digits. Currently Entered: 0 digits.
Begin Date of Service
End Date of Service
OFFER OF TEMPORARY EXTRA SERVICE
Indicate whether you accept or decline this offer of Temporary Extra Service:

Indicate whether you accept or decline this offer of Temporary Extra Service: accept decline
You have declined this offer. Please explain:
List your Extra Service work schedule (days and hours to be worked), and explain how it will be separate and distinct from your normal professional obligation:
Upload your approved UP-8 (UUP), UP-6 (M/C), or Dual Employment (other agency) form here:
maximum 5 files whose total size may not be more than 10MB
filenames should not contain more than one period (.)

You can also email this form separately to the SUNY Brockport Office of Human Resources, hrdept@brockport.edu
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
Accept this Offer by typing your name as a legal representation of your signature.
Decline this Offer by typing your name as a legal representation of your signature.
Date offer accepted or declined Date offer accepted or declined / MM / DD YYYY
ORIGINATION DETAILS - OFFICE USE ONLY
Approved by:
Approved by Dean/AVP/VP or President:
Budget Number

Extra Service Offer

Instructions:

EMPLOYEE DATA

EXTRA SERVICE APPOINTMENT AND COMPENSATION OFFER

OFFER OF TEMPORARY EXTRA SERVICE

My signature below affirms the following statements:

ORIGINATION DETAILS - OFFICE USE ONLY