Other Employment Application

This form is to be used by employees who are engaging in other employment, which includes a second job, conducting a business,
trade or profession. The form may also be used by employees actively involved with organisations in a paid or voluntary capacity,
where that involvement may conflict with their duties). The Department’s policy on other employment is available at:
http://www.education.vic.gov.au/hrweb/employcond/Pages/extemp.aspx.
Full-time employees must seek the approval of their principal/delegate to engage in any other employment. Before granting approval,
principals/delegates must be satisfied that conflicts of interest are appropriately addressed using Sections 3 and 4 of this application
form.
Part-time employees who wish to engage in other employment must consider whether it could conflict with the proper performance of
their duties. If it could, they must declare it to their principal/delegate and take reasonable steps to address any risks that could arise
from the conflict. Sections 3 and 4 of this application form are to be used for this purpose.

Privacy: The information collected on this form is for the purpose set out and is required to process your request.  Your information
will not be disclosed without your consent or unless authorised or required by law.  You are able to request access to the personal
information that the Department holds about you and request that it be corrected by contacting your Principal/Delegate. Information
about contacting Human Resources is available at: http://www.education.vic.gov.au/hrweb/Pages/contactus.aspx Information about
the Department’s privacy policy is available at: http://www.education.vic.gov.au/Pages/privacypolicy.aspx.

Section 1

Employee Details

Family Name: Given Name(s):

Employee ID: Classification:

Part Time/Full Time: School/Workplace:

Section 2

Conflict of Interest Application for Part-Time Employees:

DET Conflict of Interest policy: http://www.education.vic.gov.au/hrweb/workm/Pages/Conflict-of-Interest.aspx

I confirm that I wish to apply to engage in other employment.

I am aware of the Department’s COI policy and I believe this other employment does not conflict with the proper performance
of my duties.

Employee’s signature: ___________________________________ Date: ____ / ____ / ________

Last updated 21 November 2019

Section 3
This section is to be completed by:
 Full-time employees
 Part-time employees where the other employment may conflict with their duties

Application to Engage in Other Employment

Details of proposed other employment. [Please include nature of other employment, including location and likely hours of
work, remuneration (if any), relevant dates and expected duration. Attach any relevant documentation or additional
information.]

Period for which application made:
[To ensure periodic review, applications should be for a
maximum 12 months and should be resubmitted at the
start of each calendar year.]
For calendar year: ______ [eg. 2019]
End date: _______ [If the other employment is not
ongoing]

Does this relate to a leave application? Yes  No 

I declare that the contents of this application are true and correct.
I undertake to submit a new application in the event of any significant changes either to the other employment as identified
above or to my public duties.

Employee’s signature: ___________________________________ Date: ____ / ____ / ________

Section 4

Principal/Delegate to Complete

 Approved  The following conditions apply. [Identify any conditions which are
agreed with the employee in relation to their other employment, such as a
(For full-time employees) limitation on dates or times, the number of activities, or specific requirements
 Noted about disclosure.]

(For part-time employees

 Not approved (For full-time and part-time employees)

Reasons:

Principal/Delegate: Name and title ______________________________________________________

Signature: ___________________________________________________ Date: ____ / ____ / ________

A copy of this form should be provided to the employee and the original placed on the employee’s personnel file.

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