Corchado, George A.
CITY OF MIAMI BEACH _ _LL'l'" f-' ! .....
,REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT! U -' j i i ; :
Page 1 of 2 : , i
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I. TO BE COMPLETED BY EMPLOYEE - This Form must be completed & approved prior to
beginning any other employment
A. INFORMATION REGARDING CITY OF MIAMI BEACH eMB EMPLOYMENT
JD # DEPARTMENT' DIVISION
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WORK PHONE #
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NAME OF BUSINESS OR INDIVIDUAL. HIRING CMB EMPlOYEE
INFORMATION REGARDING OUTSIDE EMPLOYMENT
EMPLOYEE 10 #
DEPARTMENT 'DIVISION
B.
WHAT DUTIES MIGHT BE CoNSIDERED TO BE A CONFLICT OF INTEREST
NIA
A
STATE F
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This form has 2 pages - be sure to complete both pages
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT. CONTINUED
PAGE 2 of 2
c.
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 will be made on a yearly basis.
Employee Name Employee ID Number
{,olbe A.CoiLfl4do If'/3
D.
By signing below, I certify that I have read this form comoletelv and that I do not have any other emolovment. I understand
that before I start any other employment, I must reauest and obtain the above aoorovals, I further understand that failure to
comply with Outside Employment procedures could lead to disciplinary action up to and including termination of my
employment with the i~ Miami Beach.
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II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
NAME OF DEPARTMENT DIRECTOR
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NAME OF SUPERVISOR
MMLntA L. ThtlllE-.s
PLEASE CIRCLE 0
DISAPPROVED
SUPERVISOR SIGNATURE & DATE
NAME OF DIVISION HEAD
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s form has 2 pages - be sure to complete both pages
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