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Moonlighting Request & Approval Form

While there’s no law to prevent you from banning moonlighting outright, doing so will likely breed resentment, reduce morale and impair your recruiting and retention efforts. That’s why many companies have chosen not to ban moonlighting but rather limit and control it. The key to this strategy is requiring employees to notify you and get your permission to accept offers of outside employment and abide by certain ground rules in carrying out their moonlighting work. Here’s a template form you can use for employees to request permission to moonlight.



Employee Name:                                    Date:

Company Offering Outside Employment (list “self” if it’s a self-employment job):

Company Address:

Position Offered:

Description of Job Duties:

Approximate Number of Moonlighting Hours Worked Per Week:

Expected Days and Times of Moonlighting Work:

Employee Certification: I certify that the foregoing description of my requested moonlighting activities is accurate and true. I understand that any approval of the requested moonlighting activities is conditioned on my ongoing compliance with the following assurances, and will terminate upon failure to comply with any of the following:

[  ] Other job will not interfere with my job responsibilities at ABC Company.

[  ] I will not engage in secondary job activities during my scheduled ABC Company work hours.

[  ] My moonlighting activities will not constitute a conflict of interest with my duties and responsibilities to ABC Company.

[  ] I did not use my employment with ABC Company to secure this work opportunity.

[  ] My other work activities will not involve the use of ABC Company trade secrets, confidential or proprietary information.

[  ] My moonlighting activities will not involve the use of any ABC Company equipment, vehicles or other property.

[  ] I must immediately notify the HR Department of any changes to the terms of my employment.

[  ] I understand that failure to comply with any of these conditions may result in withdrawal of permission to engage in moonlighting or other disciplinary action.