FLSA Status During Dual Employment: Exempt Non-exempt Exempt: Fixed biweekly or monthly amount $ /biweekly DOS Code: DEE (Rate x Percentage to be worked): $ /monthly Non-exempt: Hourly rate: $ /hour DOS Codes: DES and DEP Employment Manager, Human Resources Sign-Off: Date: Print Name: APPROVED NOT APPROVED Date: Chancellor or Director of Human Resources (as Designee): Print Name:
FLSA Status During Dual Employment: Exempt Non-exempt Exempt: Fixed biweekly or monthly amount (Rate x Percentage to be worked): $ /biweekly $ /monthly DOS Code: DEE Non-exempt: Hourly rate: $ /hour DOS Codes: DES and DEP Employment Manager, Human Resources Sign-Off: Print Name: Date: APPROVED NOT APPROVED Chancellor or Director of Human Resources (as Designee): Print Name: Date:
Dual_Employment_Request_Form_0.docx