ANU Paid Outside Work Online Records Form

ANU Paid Outside Work Online Records Form

In accordance to the Paid Outside Work (52-day rule) Policy and Procedure, use this form to:

Record you have obtained the necessary approvals to undertake Paid Outside Work
Report Paid Outside Work undertaken in the past year

Before completing this form, make sure you have:

Reviewed the Paid Outside Work Policy and Procedure
Read through the information in the Paid Outside Work web portal
Obtained Delegate approval for the proposed paid outside work

These records will be kept by the Office of Research and Innovation Services.

University ID*

Surname*

Name*

Position title*

E.g. Research Fellow, Group Leader, etc

Type of employment*

Full-time

Part-time

Other (Honorary, Emeritus, Visiting Fellow, etc)

Please specify*

FTE fraction*

e.g. 0.8 FTE

Email address*

Your ANU email address

Phone number

College*

Select or enter value

Please specify the area*

School*

I am using this form to:*

Select or enter value

Type of Paid Outside Work*

If unsure, please refer to the Policy definitions

Select or enter value

Undertake this work in a personal capacity

Do you require ANU affiliation or resources?*

The Policy defines these as: resources paid for by the University, including (but not limited to):

University-owned Intellectual Property Rights – including that developed by the member of staff, but excluding tacit knowledge.
Time of other ANU employees and/or students
Facilities, equipment, laboratories, space and assets.
IT resources, such as ANU email accounts, phone numbers, computers, servers, telephones and printers

Select or enter value

You must undertake the work via ANU Enterprise

Visit: https://anuenterprise.com.au/personal-consultancy/

Do you require insurance?*

Select or enter value

Consider undertaking the work via ANU Enterprise

They can provide the required insurance. Visit the ANU Personal Consultancies site for further information

You may undertake the work in a personal capacity

You will need to attach proof of indemnity (Personal Indemnity and Public Liability insurance) at the end of this form.

What year are you reporting?*

Paid Outside Work days are reported per calendar year

Did you obtain Delegate approval for this work?*

If approval was not recorded using this online form (prior to August 2022), you will need to provide evidence of approval before submitting

Yes

Days on project*

How many days did you spend on the work in the past calendar year?

Do you declare that:*

Your report accurately represents your Paid Outside Work engagements for the year specified

You have abided by the requirements in the Paid Outside Work Policy and Procedure

Name of Delegate approving POW form*

Name of the person who signed your Delegate Approval form

Delegate position title*

E.g. School Director, College Dean, etc

Did you declare potential conflicts of interest?*

If you have no conflicts of interest to declare, select Not Applicable. If a conflict of interest was declared, you must attach the signed Conflict Permission Form (and Conflict Management plan, if applicable) before submitting this form.

Select or enter value

Attach the completed Delegate Approval Form*

Note:

If you have declared a conflict of interest, you also need to attach the approved Conflict Permission Request Form (mandatory) and Conflict Management Plan (if applicable)
If you are reporting on Paid Outside Work undertaken in the past year and have not recorded the approval using this form, you also need to attach evidence of delegate approval.
If you require Personal Indemnity or Public Liability insurance and are undertaking the paid outside work privately, attach evidence of insurance

Drag and drop files here or

Attachments included*

Paid Outside Work: Delegate Approval Form (for new work)

Other evidence of Delegate Approval (for work reported as undertaken in the past year)

Conflict of interest permission request form

Conflict management plan

Evidence of insurance

Send me a copy of my responses

Powered by

Privacy Notice|Report Abuse