NEW ALBANY POLICE DEPARTMENT - New Albany, Ohio

Addendum A
Request for Special Duty/Off-duty Employment
In compliance with Directive 7.1.1 (Special Duty employment) and 7.2.1 (Off-duty employment) each
officer/employee who wishes to work special duty or off-duty employment will submit a written request to the Chief of
Police for approval in January of each year. This form will be utilized by all officers/employees who wish to work
special duty or off-duty employment during the calendar year. Completed forms will be forwarded through the regular
chain-of-command for approval and will remain on file throughout the calendar year. If additional off-duty
employment occurs, an additional form is required to be completed before working the new off-duty job.
Instructions:
Complete Section 1 for and/or Section 2 for off-duty employment.
Name:
Unit Number:
Shift Schedule:
Section 1: Special Duty Employment
I am applying to work special duty within the City of New Albany. I plan to work:
White Barn Other Special Duty Assignments Both White Barn and other Special Duty Assignments
Section 2: Off - Duty Employment
Name of off-duty Employer:
Address/Location:
Nature of Employment:
Work Schedule:
Duration: Uniformed? Yes No
Request Reviewed by:
Supervisor:
Date:
Approved
Denied
Chief of Police:
Date:
Approved
Denied
PD-00-221
Revised January 7, 2011