WORD Version - In accordance with LCTCS Policy 6.018, LCTCS Form adapted for Delgado, which is used for all outside employment disclosures requiring approval of the Vice Chancellor
Immediate Supervisor : Department Head/Dean/Provost: Appropriate Vice Chancellor : [ ]Yes [ ] No [ ]Yes [ ] No [ ]Yes [ ] No 10. The outside employment involves public policy.
Immediate Supervisor : Department Head/Dean/Provost: Appropriate Vice Chancellor : [ ]Yes [ ] No [ ]Yes [ ] No [ ]Yes [ ] No ADMINISTRATIVE APPROVALS If the answer is YES to either question (3) or (10), the System President’s approval is required.
Immediate Supervisor Signature: [ ] Recommended [ ] Not Recommended Department Head/Dean/Provost Signature: [ ] Recommended [ ] Not Recommended Appropriate Vice Chancellor Signature: [ ] Recommended [ ] Not Recommended ACTION BY CHANCELLOR Chancellor Signature: [ ] APPROVED [ ] DISAPPROVED [ ] Forwarded thru Chancellor ...
Allowed
Microsoft Office Word (.doc, .dot) - application/msword
Outside Employment Form 'A' - LCTCS Form adapted for Delgado 6-7-21.doc