Beatriz A. Munoz Request for Approval of Outside Employment MIAMiBEACH
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
TO BE COMPLETED BY EMPLOYEE— 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 in be completed and approved prior 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 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami-Dade County
Code.
INFORMATION REGARDING CITY OF MIAMI BEACH EMPLOYEE
EMPLOYEES NAME:LAST NAME,FIRST NAME,MIDDLE NAME: EMPLOYEE ID NUMBER:
Munoz, Beatriz A. #15788
JOB TITLE: HOME TELEPHONE NUMBER:
Administrative Aide I 305.582.3247
DEPARTMENT/DIVISION: WORK TELEPHONE NUMBER:
Parks & Recreation/Normandy Pool 305.993.2021
SUPERVISOR'S NAME: CELLULAR TELEPHONE NUMBER:
Paul DiMuont
NORMAL WORK DAYS AND TIMES:
Monday, Wednesday,Friday, Saturday and Sunday. Closer everyday 11:30 noon-8:00, opener Saturday 7am to 3:30 pm.
INFORMATION REGARDING OUTSIDE EMPLOYMENT
NAME OF BUSINESS,ORGANIZATION OR INDIVIDUAL HIRING CMB EMPLOYEE:
Mount Sinai Medical Hospital
ADDRESS OF OUTSIDE EMPLOYER:
4300 Alton Road, Miami Beach, Fl 33140
TELEPHONE NUMBER:
305.674.2121
JOB TITLE THAT CMB EMPLOYEE WILL HOLD:
Emergency Department Tech
NAME OF OUTSIDE EMPLOYMENT SUPERVISOR:
Gus Lopez
NORMAL WORK DAYS AND TIMES:
Saturdays 7pm to 7 am.
DESCRIPTION OF DUTIES:
Caring for patients with different emergency needs of medical care from 2nd degree trauma,cardiac,pshycological,grastrointestinal,and others.
WHAT DUTIES MIGHT BE A CONFLICT OF INTEREST WITH YOUR CMB POSITION?
None
WILL YOUR PROPOSED OUTSIDE EMPLOYER RELEASE YOU IF AND WHEN YOU ARE CALLED FOR EMERGENCY SERVICE BY THE CITY?
I 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 2of2
By signing below, I certify that all of the information given on page one (1) of this document is true, 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:
Beatriz A. Munoz #15788
EMP SIG DATE:
11/07/2016
TO BE COMPLETED BY EMPLOYEE'S SUPERVISOR, DIVISION DIRECTOR, DEPARTMENT DIRECTOR,
ASSISTANT CITY MANAGER AND CITY MANAGER
NAME OF SUPERVISOR PLEASE CIRCLE ONE: SUPE- I.y!-SIGNATURE&DATE
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If you have any questions regarding outside employment, pleat- conta•i the Human Resources Department at
305.673.7524.
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