Other Work (Outside Employment)
Declaration and Approval
This form is to be used by employees who are engaging in other work (outside employment), which includes a
second job, conducting a business, trade or profession, or active involvement with other organisations (paid
employment or voluntary work). All employees who wish to engage in other work are expected to complete the
relevant parts of this Form. The Department’s policy on other work is available at:
http://www.education.vic.gov.au/hrweb/employcond/Pages/extemp.aspx.
Full-time employees must seek the approval of their principal/manager to engage in any other work. Before
granting approval, principals/managers 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 work must consider whether it could create a conflict of interest.
If it could, they must report the risks to their principal/manager and take reasonable steps to address any actual,
potential or perceived conflict. Principals/managers must be satisfied that conflicts of interest are appropriately
addressed prior to an employee engaging in other work. Sections 3 and 4 of this application form are to be used for
this purpose.
PRIVACY
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/Manager. 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):
School/Workplace:
Employee ID: …………………………………
…………………………………………………………………
Classification: ……………………………….
Part time:
Full time:


Section 2
CONFLICT OF INTEREST DECLARATION FOR PART-TIME EMPLOYEES:
DET Conflict of Interest policy: http://www.education.vic.gov.au/hrweb/workm/Pages/Conflict-of-Interest.aspx
I declare that I wish to engage in other work.
I am aware of the Department’s COI policy and I believe this other work does not create a conflict of
interest for me.
Signed by employee: …………………………………………………………………………………………………….
___________________________________________________________________________________________________________________
Other Work (Outside Employment) Declaration and Approval
Last Updated 1 January 2015
Section 3
APPLICATION TO ENGAGE IN OTHER WORK
This section is to be completed by:

Full-time employees

Part-time employees who consider their other work may create a risk of conflict of interest
Details of proposed other work. [Please include nature of other work, 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. 2012]
Does this relate to a leave application?
Yes
End date: _______ [If the other work is not ongoing]

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 work as
identified above or to my public duties.
Employee’s signature __________________________________________________ Date: ___/____/___
Section 4
PRINCIPAL/MANAGER TO COMPLETE

Approved
(For full-time employees)

Noted

The following conditions apply. [Identify any conditions
which are agreed with the employee in relation to their other
work, such as a limitation on dates or times, the number of
activities, or specific requirements about disclosure.]
(For part-time employees)

Not approved (For full-time and part-time employees)
Reasons:
Signed ___________________________________________________
Date: ____/____/____
Name and title (principal/manager): ______________________________________________________
RECORD MANAGEMENT
A copy of this form should be provided to the employee and the original placed on the employee’s personnel file.
___________________________________________________________________________________________________________________
Other Work (Outside Employment) Declaration and Approval
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