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
Date
Submit Waiver
Submit Waiver
Should be Empty: