Program Manual - Saint Louis University

SAINT LOUIS UNIVERSITY
CENTER FOR ADVANCED DENTAL EDUCATION
OUTSIDE EMPLOYMENT FOR GRADUATE STUDENTS
Request for Employment
Please fill out the top portion of this form and submit it to your Program Director. He will
present your request to the Board of Directors. You will be notified of their decision following a
review of your request.
Upon employment, you are required to present a typed, signed letter to the Program Director
giving the name of the doctor or the organization for whom you will be employed, the address
and telephone number.
If approved, I will seek employment outside of the Center for Advanced Dental Education during
the remainder of my graduate program. I am aware that my outside employment will consist of
general practice only and that I agree to follow all policies that exist or may be enacted regarding
outside employment.
___________________________________________
Printed Name
___________________________________________ ________________
Signature Date
...........................................................................................................................................................
Approved or Not Approved:
_________________________________________ __________________
Program Director Date
_________________________________________ __________________
Executive Director Date
...........................................................................................................................................................
To be filled in by the Administrative Office:
Name of Employer ____________________________________________
Address_____________________________________________________
Phone_______________________________