ࡱ> =?< jbjb 1"̟̟ MMMM Y4\h HJJJJJJ!lJhhJ_HHnoMu0""MM {:   PM-11 FORM B Disclosure of Outside Employment Requiring Approval by the Chancellor or President Louisiana State žŸ in Shreveport If outside employment requires approval by the Chancellor or the President, the employee must follow the certification and contractual provisions of PM-11 under the Approval Level section for outside employment. All required documents shall be attached to and made part of this Disclosure Form before submission through administrative channels for review by the chancellor. The following approvals must be obtained before engaging in the proposed outside employment. Form must be typed. EMPLOYEE DISCLOSURE  Employee's Name: Proposed outside employer or business: Amount of Proposed Compensation: Date:  APPROVAL/CERTIFICATION BY CHANCELLOR The outside employment activities are not within the course and scope of the employee's duties to the žŸ for which the employee is being compensated by the žŸ. The outside employment activities do not conflict, delay or in any manner interfere with instructional, scholarly and/or services which the employee is obligated to perform for the žŸ. The consulting activities to be performed are within the academic or professional discipline of the employee or are related to the areas of expertise in which the employee is employed by the žŸ. Signature: Chancellor Date Louisiana State žŸ in Shreveport  OUTSIDE EMPLOYMENT INVOLVING PUBLIC POLICY OR A STATE AGENCY [ ] APPROVED [ ] NOT APPROVED  Signature: President Date:   _`` s v x c 5 X   * %(`:v*,]ε絨絨絨hZK>*CJOJQJaJhZKCJOJQJaJhZK6OJQJ]aJhZKOJQJaJhZK5CJOJQJ\aJhZKCJOJQJhZK5CJ$OJQJ\aJ$ `v w x d xikd$$Ifx,,  04 xaxp :$If$If d$If$a$ d g h 6 7 8      + d$IfYkd$$Ifx,,04 xax:$If$If + , - qr}~a 6$If d$Ifikd]$$Ifx,,  04 xaxp 6789:w d$IfYkd$$Ifx,,04 xax:$Ifwxyz^:$If$If d$Ifikd$$Ifx,,  04 xaxp lkdq$$Ifx0p,pV$04 xax/0PBP/ =!h"#h$h%hh$$Ifx!vh5,#v,:V x  05,/ 44 xaxp $$Ifx!vh5,#v,:V x05,/ / 44 xax$$Ifx!vh5,#v,:V x  05,/ 44 xaxp $$Ifx!vh5,#v,:V x05,/ / 44 xax$$Ifx!vh5,#v,:V x  05,/ 44 xaxp $$Ifx!vh5p5V$#vp#vV$:V x05p5V$/  / / /  44 xax6666666662 0@P`p2( 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p 0@P`p8XV~_HmH nH sH tH P`P Normal1$7$8$H$OJQJ_HaJmH sH tH DA D Default Paragraph FontVi@V  Table Normal :V 44 la (k (No List <& < Footnote ReferencePK!K[Content_Types].xmlj0Eжr(΢]yl#!MB;BQޏaLSWyҟ^@ Lz]__CdR{`L=r85v&mQ뉑8ICX=H"Z=&JCjwA`.Â?U~YkG/̷x3%o3t\&@w!H'"v0PK!֧6 _rels/.relsj0 }Q%v/C/}(h"O = C?hv=Ʌ%[xp{۵_Pѣ<1H0ORBdJE4b$q_6LR7`0̞O,En7Lib/SeеPK!kytheme/theme/themeManager.xml M @}w7c(EbˮCAǠҟ7՛K Y, e.|,H,lxɴIsQ}#Ր ֵ+!,^$j=GW)E+& 8PK!\theme/theme/theme1.xmlYOoE#F{o'NDuر i-q;N3' G$$DAč*iEP~wq4;{o?g^;N:$BR64Mvsi-@R4Œ mUb V*XX! cyg$w.Q "@oWL8*Bycjđ0蠦r,[LC9VbX*x_yuoBL͐u_. DKfN1엓:+ۥ~`jn[Zp֖zg,tV@bW/Oټl6Ws[R?S֒7 _כ[֪7 _w]ŌShN'^Bxk_[dC]zOլ\K=.:@MgdCf/o\ycB95B24S CEL|gO'sקo>W=n#p̰ZN|ӪV:8z1f؃k;ڇcp7#z8]Y / \{t\}}spķ=ʠoRVL3N(B<|ݥuK>P.EMLhɦM .co;əmr"*0#̡=6Kր0i1;$P0!YݩjbiXJB5IgAФ޲a6{P g֢)҉-Ìq8RmcWyXg/u]6Q_Ê5H Z2PU]Ǽ"GGFbCSOD%,p 6ޚwq̲R_gJS֣9)嗛(:/ak;6j11太x~<:ɮ>O&kNa4dht\?J&l O٠NRpwhpse)tp)af] 27n}mk]\S,+a2g^Az )˙>E G鿰L7)'PK! ѐ'theme/theme/_rels/themeManager.xml.relsM 0wooӺ&݈Э5 6?$Q ,.aic21h:qm@RN;d`o7gK(M&$R(.1r'JЊT8V"AȻHu}|$b{P8g/]QAsم(#L[PK-!K[Content_Types].xmlPK-!֧6 1_rels/.relsPK-!kytheme/theme/themeManager.xmlPK-!\theme/theme/theme1.xmlPK-! ѐ' theme/theme/_rels/themeManager.xml.relsPK] " `vwxdgh678+,-qr}~a 6 7 8 9 : w x y z ^ h{0$hh{0$hh{0$hh{0$hh{0$hh{0$hAAA(d=kAAAAAAAAAAh{0$hA:A:OpA:A:A:A:A:A:A:A:A:A:A:A:A:A:h{0$hAAAAAAAAAAAAAAA,h{0$hh{0$h d + 6w 8@0(  B S  ? QuickMark vw+,7 8 9 w x w@ @UnknownGTimes New Roman5Symbol3 ArialY CG TimesTimes New RomanK5  CourierPSCambria" hΓ&Γ&I  xx2d D3 HX)?K2 PM-11 FORM BbtaylorLaurel Hundley Oh+'0  < H T`hpx'PM-11 FORM Bbtaylor Normal.dotmLaurel Hundley2Microsoft Word 12.1.0@@4n@4n ՜.+,0 hp  'LSU Shreveport   PM-11 FORM B Title  !"#$%&'()*+-./012356789:;>Root Entry F/oo@Data 1Table"WordDocument1"SummaryInformation(,DocumentSummaryInformation84CompObj`ObjectPool.oo.oo F Microsoft Word 97-2004 DocumentNB6WWord.Document.8