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Out-of-State Work Request/Approval Form

Personnel Policy #132 – Work locations outside of New York State or the United States

*This form is for department administrators and/or managers. 

To have an out-of-state employment scenario reviewed and approved (new hire or relocation), please complete the following information: PLEASE ALLOW AT LEAST 4-6 WEEKS (4-5 Months for Out-of-Country) FOR REVIEW. INDIVIDUAL CANNOT WORK UNTIL APPROVAL IS RECEIVED

APPLIES TO: All Full-time and Part-time employees, which for the purpose of this policy includes: faculty, staff, residents and fellows, research associates, postdoctoral appointees and student employees.

"*" indicates required fields

What type of request is this? * Required


Requester information

Employee/Candidate name * Required







The department will be charged quarterly for any employee working out of state. Additional fees may apply.
Is there an offer pending for this employee? * Required


Employment status * Required



*When the work location is not required for the work to be performed students and TAR staff should be paid through a payrolling agency in that work location. Email HROutofStateRequest@rochester.edu for assistance.
Payroll status * Required


Please use the format MM/DD/YYY.

*If request is not for a UR designated location, approval to work out of state may be limited to a maximum of one year and will require a new request form be submitted at least 4-6 weeks prior to the end date to allow time to re-evaluate employment regulations for that state to ensure we are able to remain compliant. Please use the format MM/DD/YYY.

Where work is to be performed

(approx. if unknown)
Will the employee/candidate be a resident of the out-of-state location requested? * Required


Business need/justification for out-of-state request

Max. file size: 20 MB.