Moonlighting Request Form

NOTICE: 
This Moonlighting Request Form must be submitted as soon as the 
moonlighting assignment has been made.

PREREQUISITES
Trainee is NOT permitted to moonlight on an Ohio Training Certificate.
Federal regulations prohibit trainees on J-1 Visas from working or receiving compensation for activities outside the approved training program, including moonlighting.
Trainees who have not fulfilled the obligations of the GME program are not permitted to moonlight.
MED PED RESIDENTS ONLY
REQUEST
By clicking "Submit" below, you are electronically signing that you agree to the below statement.
I understand that moonlighting is in addition to the regular duties of my residency. I believe this moonlighting activity will not interfere with my ongoing patient care and educational responsibilities. I understand that future requests to moonlight are contingent upon my ability to successfully complete all of my regularly assigned resident duties. I further attest that I have met all of the conditions outlined in the GME policy on Moonlighting, including visa status, available on the Children’s website: http://www.nationwidechildrens.org/gme-policies-and-procedures

Reminders:

Please remember to fill out Moonlighting forms for all shifts for record keeping purposes. However, please remember if you are Moonlighting in the ED you need to make sure you are turning in the additional form required by the ED.

Visa Status for Moonlighting

**For the protection of the resident, the Program Director must assure that an international resident does not violate his/her legal status by moonlighting.

Federal regulations stipulate that residents on J-1 visas may not work or receive compensation for activities outside the approved training program, AS A RESULT, J-1 VISA HOLDERS MAY NOT MOONLIGHT UNDER ANY CIRCUMSTANCES. 

Federal regulations stipulate that residents on H1-B visa must apply and be approved for additional H1-B sponsorship in order to be employed outside their approved program.  Program Directors must contact the GME Office (722 4905) to confirm that a resident on a H1-B visa is legally permitted to moonlight.