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CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
Page 1 of 2
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 (CMB EMPLOYMENT
10# DEPARTMENT I DIVISION
EMPLOYEE NAME: LAST NAME, FIRST NAME, MIDDLE NAME
12620 NEIGHBORHOOD SERVICES I CODE COMPLIANCE DIVISION
GARCIA, MERCEDES MARIA
WORK PHONE # HOME PHONE #
JOB TITLE
ADMINISTRATIVE AIDE II 305-673-7000 X (305) 824-1981
6011
WORK PHONE # EMPLOYEE'S OTHER PHONE #S (BEEPER, CELL)
SUPERVISOR VIVIAN GUZMAN
305 673 7000 X
6749
To BE COMPLETED BY SUPERVISOR: Do YOU AGREE WITH THE
NORMAL WORK DAYS AND TIMES INFORMATION IN THIS SECTION? YES No
MONDAY TO FRIDAY (8:30 A.M. TO 5:00 P.M.)
B. INFORMATION REGARDING OUTSIDE EMPLOYMENT
EMPLOYEE 10 # DEPARTMENT I DIVISION
NAME OF BUSINESS OR INDIVIDUAL HIRING CMB EMPLOYEE
KEYES
THE KEYES COMPANY I REALTORS
WORK PHONE # TYPE OF BUSINESS
JOB TITLE REAL TOR I ASSOCIATE (305) 823-6000 REALTOR
WORK PHONE #
SUPERVISOR MODESTO (305) 823-6000
DATE OF HIRE
NORMAL WORK DAYS AND TIMES
07 - 2002
ADDRESS OF BUSINESS: STREET
13905 NW. 6ih Ave. CITY MIAMI LAKES STATE FL ZIP 33014
DESCRIPTION OF DUTIES
Realtor I Associate
WHAT DUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST
I see no conflict, but I was advised that I can not work Real Estate in the City of Miami Beach.
This form has 2 pages - be sure to complete both pages
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT - CONTINUED
PAGE 2 of2
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 Employee signature & Date .
, r "\1 j~~~ 1.2.. -':1.7- Iff
Mercedes M. Garcia 12620 /, i.J ICe c.f2
D.
By signing below, I certify that I have read this form completely and that I do not have any other employment. I understand
that before I start any other employment, I must reQuest and obtain the above approvals, 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 City Of Miami Beach.
EMPLOYEE SIGNATURE
DATE
Il- /z., ('1
I JD NUM."
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I E."o,." NAM'
II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
NAME OF SUPERVISOR
PLEASE CIRCLE ONE
DISAPPROVED
SUPERVISOR SIGNATURE & DATE
NAME OF DIVISION HEAD
NONE AT THIS TIME
PLEASE CIRCLE ONE APPROVED
DISAPPROVED
\- S' {)~
VIVIAN GUZMAN
NAME OF DEPARTMENT DIRECTOR
VIVIAN GUZMAN
PLEASE CIRCLE ONE APPROVED
DISAPPROVED
DEPARTMENT HEAD SIGNATURE & DATE
CITY MANAGER
PLEASE CIRCLE ONE APPROVED
DISAPPROVED
CITY MANAGER SIGNATURE & DATE
This form has 2 pages - be sure to complete both pages
M:\$CMB\HUMARESO\Outside Employment Form 1006 03.doc
REV: 10/06/03