Ruben A. Rayneri Request Approval for Outside Employment 2016 MIAMIBEACH
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
TO BE COMPLETED BY EMPJOYEE•-City of Miami Beach employees may accept outside employment as long as
the employment Is not contrary, detrimental or adverse to the Interests of the City, and as long as no City time,
equipment or material is used.
This form must be completed and approved i&E to beginning any outside employment. Requests for approval of
outside employment must be made on a yearly basis (even if for the same outside employment that had been
previously approved).
City employees engaging in outside employment must also file an °Outside Employment Statement"form with the
Office of the City Clerk by July 18' of each year, in accordance with Section 2-11.1(kX2)of the Miami-Dade County
Code.
INFORMATION REGARDING CITY OF MIAMI BEACH EMPLOYEE
EMPLOYEES NAME LAST NAME.FIRST NAME.MIDDLE NAME EMPLOYEE lb NUMBER:
Rayneri, Ruben,Armando 17032
JOB TITLE: HOME TELEPHONE NUMBER
Firefighter 1
DEPARTMENTIDMSION: WORK TELEPHONE NUMBER:
1240- Fire Support Services
SUPERVISOR'S NAME CELLULAR TELEPHONE NUMB
Javier Ottero 305.989.4018
NORMAL WORK DAYS AND TIMES:
96hr work week
INFORMATION REGARDING OUTSIDE EMPLOYMENT
.r. 'T OFBIJ5IN .i"177-• 1ZATIONORIN.,I-illl1 •F: Bpi i.^3-•
ISC Inc.- Homestead Miami Speedway/RescueAED, LLC
ADDRESS OF OUTSIDE EMPLOYER:
1 Speedway Blvd. Homestead FL 33032/11990 SW 93 Terr Miami FL 33186
TELEPHONE NUMBER
305 255 5709/3059894018
JOB TITLE THAT CMB EMPLOYEE WILL HOLD:
Operations Chief, Emergency Services 1 Director of Operations
NAME OF OUTSIDE EMPLOYMENT SUPERVISOR
Fernando Fernandez/Self
NORMAL WORK DAYS AND TIMES:
Varies
DESCRIPTION OF DUTIES:
Safety for Fans and Drivers/Training and Medical Sales
WHAT DUTIES MIGHT BE A CONFLICT OF INTEREST WITH YOUR cue POSITION?
None
WILL YOUR PROPOSED OUTSIDE EMPLOYER RELEASE YOU IF AND WHEN YOU ARE CALLED FOR EMERGENCY SERVICE BY THE p
e YES ❑NO
This form has 2 pages—be sure to complete both pages.
Employee signature required on page 2.
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT-CONTINUED
PAGE 2 of 2
By signing below, I certify that all of the information given on page one (1) of this document is tn,e, accurate, and
complete to the best of my knowledge. I understand that all information is subject to investigation and that falsification,
omission, or misrepresentation is sufficient cause for disciplinary action, up to and including termination. I also
understand that I am responsible for informing my supervisor in writing if any information about my outside employment
changes, especially if there arises any possible conflict of Interest. Failure to do so may lead to disciplinary action,
Including termination of employment with the City of Miami Beach. This request for approval of outside employment will
be made on a yearly basis.
EMPLOYEE NAME: EMPLOYEE ID NUMBER:
Ruben Rayneri 17032
EMPLOYEE -- - DATE: 00 —
TO BE COMPLETED BY EMPLOYEE'S SUPERVISOR, DIVISION DIRECTOR, DEPARTMENT DIRECTOR,
ASSISTANT CITY MANAGER AND CITY MANAGER
NAME U R PLEASE CIRCLE ONE SUPERVISO NAI &DATE 1/
-S` 0 *era O DISAPPROVED s- 3 )- L1 _
OF DIVISION DIRECTOR PLEASE CIRCLE ONE: D N DI- •R SIGNATURE&DATE
APPROVED DISAPPROVED I /
NA. g.DEPARTMENT DIRECTOR PLEASE CIRCLE ONE: ' P Alf r CTORSIGNATURE8DATE
L. Z . S G I
(p
ASSISTANT
CITY MANAGER `-y L CIRCLE ONE: • TANT CITY MANAGER SIGNATURE&DATE
APPROVED DISAPPROVED
CITY MANAGER PLEASE CIRCLE ONE: CITI(MANA SIGNATURE&DATE
mmci L f'C�O Id AP DISAPPROVED - G/b�6
If you have any questions regarding outside employment, plea conta the Human Resources Department at
305.673.7524.
M:1ECMe1HUMARESOIOUTSIDE EMPLOYMENT Rvlsed 04182011.dooc