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					                                                                                       For Compensation Office Use Only
                                                                               File:           Unit:            Yr.:

Human Resources Division                                                       Date Approved:
Compensation Office
7 East 12th Street, 2nd Floor                                                  Approved By:
New York, NY 10003-4475
(212)998-1260
compensation@nyu.edu

                                     Request For An Extension Of Employment (Code 115)
Name:               _______________________ Requested End Date:                ________________________
Employee ID:        _______________________               Unit:                ________________________
Rate:               _______________________               Dept:                ________________________


                   Please check the category below which describes this employee and complete
                       the chart for the twelve week period prior to the employee’s end date.

  Work hours are 14 per week or less
  Work schedule is intermittent (Employee is not on a regular work schedule and is periodically asked to work).

                                                             OR
   Explain below why you believe an exception to the Code 115 Extension guidelines should be approved (e.g., a part-time
   regular position is to be created).




  Please provide account funding information:

_____________       ________ _____________ ____________ _____________
Account             Fund     Org           Program      Project

Week:                                     Pay Period:                Total Hours                     Comments**
                                                                     Per Week:
               1                          4/1/96—4/7/06                       12
               2                          4/8/96—4/14/96                       0                     Employee not scheduled to
                                                                                                     work.

              1
              2
              3
              4
              5
              6
              7
              8
              9
             10
             11
             12

             12                  Total:                                                       0.00

* Indicate “0” if no hours worked
** State reason in comments field for any weeks with “0” hours worked (e.g., holiday, etc.)

_______________________________________________________________                                      ______________________
Signature of Human Resources Officer                                                                 Date

                   http://www.nyu.edu/hr · compensation@.nyu.edu · tel: 212.998.1260 · fax: 212.995.4246
                                     form: ctempext.pdf ·· last revised: 07/06/05 ·· page 1/1

				
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