Education Staff Extra Duty Work Waiver Form
Please complete this form to acknowledge and provide details regarding your voluntary or agreed extra duty assignment.
Full Name
*
First Name
Last Name
Position/Title
*
School/Department
*
Description of Extra Duty Assignment
*
Scheduled Date(s) of Extra Duty
*
Scheduled Time(s) or Period
*
Signature
*
Date Signed
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Submit Waiver
Submit Waiver
Should be Empty: