Secondary Employment and Extra-Official Activities - Sydney South ...
Secondary Employment and Extra-Official Activities - Sydney South ...
Secondary Employment and Extra-Official Activities - Sydney South ...
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Attachment 3<br />
Staff Specialist – Notification Form for <strong>Secondary</strong><br />
<strong>Employment</strong>/Participation in an Outside Business<br />
[for part-time staff specialists]<br />
I am employed as a part-time staff specialist <strong>and</strong> I am writing to advise of my Outside Practice in terms of the<br />
provisions of Clause 15 of the Staff Specialists (State) Award (the “Award”).<br />
Surname: ____________________________________ First Name(s):______________________________<br />
Facility Name: __________________________________________________________________________<br />
Department:____________________________________________________________________________<br />
Employee Number: _______________________Classification:___________________________________<br />
1) I certify that the Outside Practice:<br />
………………………………………………………………………………………………………………<br />
(Name of the Outside Practice)<br />
located at…… ………………………..……..………………………………………………………....…<br />
(the “Outside Practice”)<br />
does not conflict with my commitments in providing normal duties or on call requirements as a part time<br />
Staff Specialist / Medical Practitioner in the provision of services to public patients <strong>and</strong> / or to services<br />
provided by the <strong>Sydney</strong> <strong>South</strong> West Area Health Service at:<br />
Day(s) Hospital /Facility Hours<br />
Monday From: To:<br />
Tuesday From: To:<br />
Wednesday From: To:<br />
Thursday From: To:<br />
Friday From: To:<br />
Saturday From: To:<br />
Sunday From: To:<br />
(Name all <strong>Sydney</strong> <strong>South</strong> West Area Health Service hospitals <strong>and</strong> facilities where you are employed to perform work)<br />
2) I certify that my participation in the Outside Practice will not conflict with my obligations under the Code<br />
of Conduct issued by the NSW Department of Health, as varied from time to time.<br />
3) I certify that I will only participate in the Outside Practice on the days <strong>and</strong> between the hours listed<br />
below <strong>and</strong> I will immediately notify my General Manager / Area Service Director of any change to this<br />
pattern.<br />
Day(s)<br />
Hours<br />
Monday From: To:<br />
Tuesday From: To:<br />
Wednesday From: To:<br />
Thursday From: To:<br />
Friday From: To:<br />
Saturday From: To:<br />
Sunday From: To: