Letty Ducos 2023DocuSign Envelope ID: B6780118-7738-4B52-8201-2FE835237704
r , BEACH
CITY OF MIAM I BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
T O B E C O M P L ETED 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. (See Administrative Order HR.15.01)
This form must be completed by the requesting employee and fully 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
Offi ce of the City Clerk by July 1" 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
EM P LO Y E E 'S NA M E: LA S T NA M E , FIR S T N AM E. M ID DLE N A M E : E M P LO Y E E ID N UM B E R :
DUCOS, LETTY A. 20060
JO B TITLE : HOME TELEPHONE NUMBER:
OFFICE ASSOCIATE V N/A
D E P A RTM E NT/DI V IS IO N : W O R K TE LE P HO N E N U M B E R:
PLANNING 305-673-7000 EXT. 26179
S U P E R VI S O R 'S N A M E : CE LLULA R TE LE P H O N E N UM B E R :
LYDIA SACHER 786-583-2163
N O R M AL W O R K D A Y S A N D TIM E S :
M-F; 8-30 AM TO 5:00 PM
INFORMATION REGARDING OUTSIDE EMPLOYMENT
NA M E OF BU S IN E S S . O R G A N IZA TIO N OR IN D IV ID U A L HI RI N G CM B EM PL O YE E .
KILL BURN MEDIA- THE NIGHT GARDEN AT FAIRCHILD TROPICAL GARDENS
A D DR ES S OF OUT S ID E EM P LO Y E R :
10901 OLD CUTLER ROAD, MIAMI, FL 33156
TE LE P H O N E N U M B E R:
(808) 216-0514
JO B TITLE THA T CM S EM P LO Y E E W ILL HO LD :
EVENT STAFF
N A M E OF OUTS ID E EM P LO Y M E NT S U P E RV IS O R:
TRISTEN HAEDO
NO R M AL W O R K D A Y S A N D TIM E S :
SAT & SUN, 5:15 PM TO 11:15 PM
D E SC R IP TIO N OF DUT IE S :
WAYFINDER- GREETING ATTENDEES, DIRECTING TO ATTRACTIONS AND KEY AREA LOCATIONS
W HA T DUT IE S M IG H T B E A CO N FLI C T O F IN TE R ES T W IT H YO U R C M B PO S ITIO N ?
NONE
W ILL YO UR PR O P O S E D O U TS ID E EM P LO Y E R R E LE A S E Y O U IF A N D W H E N YO U A R E C A LLE D FO R EM E R G E NC Y SE RV IC E BY TH E CITY ?
7 YES ONO
This form has 2 pages - Be sure to complete both pages.
Employee signature required on page 2
DocuSign Envelope ID: B6780118-7738-4B52-82C1-2FE835237704
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT - CONTINUED
PAGE 2 of2
By sig n ing be lo w , I ce rt ify th a t all of th e info rm atio n give n on page one (1) of this docum ent is true, accurate, and
co m p le te to the be st of m y kn o w le d g e. I ce rt ify that m y outside em plo ym e nt w ill no t create or cause any conflict of interest
w ith m y prim a ry em p lo ye r, the C ity of M ia m i Beach. I understa nd tha t all in fo rm ation is subject to investigation and that
falsifica tio n , o m issio n , or m isre p re se nta tion is suffi cient ca use fo r disciplin ary action, up to and including term ination.
I also und e rstan d tha t I am re sp o n sib le fo r info rm ing m y sup e rv iso r in w riting if any info rm ation about m y outside em ploym ent
cha n g e s, espe cia lly if th e re arises an y po ssib le co nfli ct of interest. Fa ilure to do so m ay lead to disciplinary action,
inclu d in g te rm in a tio n of em p loym en t w ith the C ity of M ia m i B each . This req ue st fo r appro val of outside em ploym ent w ill be
m a d e o n a ye a rly ba sis.
EMPLOYEE NAME:
LE TT Y A. D U C O S
EMPLOYEE ID NUMBER.
2UU6U
DATE
11/8/23
TO BE COMPLETED BY EMPLOYEE'S SUPERVISOR, DEPARTMENT DIRECTOR, HUMAN RESOURCES DIRECTOR,
AND ASSISTANT CITY MANAGER
Pease print approver's name below. Pease sign and_date below
N AM E O F SU PER VISO R
LY D IA SA C H E R
NAM E OF DEPARTM ENT DIR ECTO R
THOMAS MOONEY
HUMAN RESO URCES DIRECTO R
Marla Alpizar
ASSISTANT CITY MANAG ER
kiczet
DATE
/2r
Ap p r o val R e strictio n s (if app lica bl e ).
D e n ia l R e a so n (if ap p lica b le)
lf you have any questions regarding outside employment, please contact the Human Resources Department at 305 673 7524
M \$CMBIHUMARESO\Employee Forms\Outside Employment Approval Request_Updated 08 15.23
DocuSign Envelope ID: B6780118-7738-452-8201-2FE835237704
MIAMI-DIU>E. EI.E
OUTSIDE EMPLOYMENT STATEMENT
For Full-time County and Municipal Employees
Full-time County (including Public Health Trust) and municipal employees engaging in outside employment must file an annual disclosure report
by July 1st of each year, in accordance with Section 2-11.1(k)(2) of the Miami-Dade County Code.
Disclosure for Tax Year Ending I Last Name First Name Middle Name/Initial
100 DUCOS LETT Y A
Mailing Address - Street Number, Street Name, or P.0. Box
3044 NW 31 ST STREET
City, State, Zip
MIAMI, FL 33142
If your home address is exempt from public records pursuant to Florida Statutes $119.07, please see note on the following page and check here. D
Filing as an Employee (check one)
D County D Public Health Trust [] Municipal CITY OF MIAMI BEACH
(Municipality)
Department Division
PLA NNING DEPARTMENT N/A
Position or Title Employee ID Number I Work telephone
OFFICE ASSOCIATE V 20060 (305) 673-7550
Please list the sources of outside employment (including self-employment), the nature of the work, and the total amounts of money or other
compensation you received for each source of outside employment. If no income or compensation was received from a particular outside
employment, enter zero (0) for that organization in the section below. If continued on a separate sheet, check here. 0
Name and Address Nature of the Total Amount of Money or
of the Source of Outside Income Work Perfonned Compensation Received
KILL BURN MEDIA - THE NIGHT GARDEN EVENT STAFF (WAYFINDER) - GREETING $1,620.00
AT FAIRCHILD TROPICAL GARDENS ATTENDEES, DIRECTING TO ATTRACTIONS AND KEY
AREA LOCATIONS AT S15/HOUR
I hereby swear (or affirm) that the information above is a true and correct statement.
Date signed
RECEIVED BY ELECTIONS DEPARTMENT:
_Hardcopy
_ Electronic Copy
OFFICE USE ONLY Accepted Y / N Deficiency
38 0122 COE 20Y6
Processed Date/initials Scanned D0ate/Initials
D o c u S ig n E n v e lo p e ID : B 6 7 8 0 11 8 -77 3 8 -4 8 5 2 -8 2 C 1-2 F E 8 3 5 2 3 77 0 4
OUTSIDE EMPLOYMENT INFORMATION
Required by the Miami-Dade County Code, Section 2-11.1(k)(2)
OUTSIDE EMPLOYMENT means providing personal services, other than to Miami-Dade County, or
to the respective municipality, that are compensated or traditionally compensated, including but not
limited to, being an employee, an independent contractor, an agent, or by self-employment. Please
note that this form is to be used only to report Outside Employment; it is separate from the Source of
Income Statement. If you are required to file a Source of Income Statement and you also engage in
outside employment, you must complete both the Outside Employment Statement and the Source of
Income Statement.
FILING INSTRUCTIONS
This form must be filed by July 1st of each year.
The form should only be filed by employees who have outside employment to disclose.
Miami-Dade County full-time personnel (including Public Health Trust personnel) shall file
completed forms with:
Miami-Dade Elections Department
Attn: Financial Disclosure Section
2700 NW 87th Avenue
Miami, FL 33172
or
P.O. Box 521550
Doral, FL 33152-1550
or
through email:
financial.disclosures@miamidade.gov
Municipal full-time personnel shall file completed forms with their respective Municipal Clerk.
For further information, Miami-Dade County and Public Health Trust employees may contact the
Miami-Dade Elections Department Financial Disclosure Section via telephone at 305-499-8413 or via
email at financial.disclosures@miamidade.gov. Municipal employees may contact their respective
Municipal Clerk's Office.
Note RE: Florida Statutes S 119.07: The role of our office is to receive and maintain forms filed as public records.
If your home address is exempt from disclosure and you do not wish your home address to be made public, please
use your office or other address for your mailing address. The following persons are exempt from disclosing their
home addresses: active or former law enforcement personnel, including correctional and correctional probation
officers, personnel of the Department of Children and Family Services whose duties include the investigation of
abuse, neglect, exploitation, fraud, theft, or other criminal activities, personnel of the Department of Health whose
duties are to support the investigation of child abuse or neglect, and personnel of the Department of Revenue or
local governments whose responsibilities include revenue collection and enforcement or child support enforcement;
firefighters; justices and judges; current or former state attorneys, assistant state attorneys, statewide prosecutors,
or assistant statewide prosecutors; county and municipal code inspectors and code enforcement officers.
COE 2016