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Get NY OP-175 2021-2024

Signature of Per Session Program Supervisor OP-175 2017-2018 Summary of Chancellor s Regulation C-175 school maintains a copy of the Standard Operating Procedures Manual for Schools SOPM. Chancellor s Regulation C-175 2017-18 APPLICATION FOR PER SESSION EMPLOYMENT AND CLAIM FOR RETENTION RIGHTS OP-175 Directions This form must be completed and submitted to the per session supervisor prior to commencement of employment in a per session activity. A copy of this form must be retained by the per session supervisor. An applicant who wishes to claim retention rights must assert such a claim on this form* Retention rights may be claimed ONLY in one per session activity. No person may work more than 400 hours in one or a combination of per session activities with a maximum of 270 hours in a school psychologist and/or school social worker position without prior written approval of the Division of Human Resources in accordance with Chancellor s Regulation C-175. Last Name First Name Home Address Home Phone File No* 1. Are you a full-time employee of the NYC Department of Education If yes indicate current work location CFN MI Zip Code Email Address Yes District No School/Office License or Title Hours of Employment from to 2. Per Session Position for which you are Applying Program Name CFN District Approximate Start Date Do you claim retention rights Yes No Approximate Total No* of Hours in Activity Work Hours Monday Friday to Saturday Sunday to 3. Between July 1 2017 and June 30 2018 have you worked or do you plan to work in any other per session activity Yes No. If yes indicate all positions below. Use additional sheets if necessary. a* Program Name CFN 4. Will your total per session hours for this year including the hours for the position for which you are applying exceed 400 Yes No 5. If yes have you submitted a waiver request to exceed the 400 hour maximum Yes No 6. Declaration I have read and understand the requirements in Chancellor s Regulation C-175. I understand that I am bound by this regulation* I affirm that the information given above is to my knowledge accurate and complete and I understand that a willfully false answer to any question contained herein is a Class E felony which shall render this application null and void and may result in loss of retention rights cancellation of per session employment loss of pay recoupment of compensation already paid and/or disciplinary action* Signature of Applicant Date 7. Approval by Per Session Supervisor I certify that this applicant possesses the qualifications established for the position and that the selection was made after following advertising procedures set forth in Chancellor s Regulation C175. Individuals may review a copy of these procedures in order to familiarize themselves with the process by which per session employees are processed and paid* 1. All per session employees must complete an application for per session activity OP175 prior to commencing service. 2. Individuals who have been approved for waivers in prior years must resubmit new waiver applications each year.

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