Sanders, Willie Mose
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
I. TO BE COMPLETED BY EMPLOYEE
A. INFORMATION REGARDING CITY OF MIAMI BEACH CMB EMPLOYMENT
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EMPLOYEE NAME: LAST NAME, FIRST NAME, MIDDLE NAME
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Joe TITLE W akoJ~ S~
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WORK PHONE # HOME PHONE #
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SUPERVISOR
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WORK PHONE # EMPLOYEE'S OTHER PHONE #5 (BEEPER, CELL)
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NORMAL WORK DAYS AND TIMES
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TO BE COMPLETED By SUPERVISOR:
Do YOU AGREE WITH THE INFORMATION IN THIS SECTION?
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NO
B:INFORMATION REGARDING OUTSIDE EMPLOYMENT
NAME OF BUSINESS OR INDIVIDUAL HIRING CMB EMPLOYEE
EMPLOYEE ID #
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JOB TITLE
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TYPE OF BUSINESS I {
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WORK PHONE #
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SUPERVISOR
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WORK PHONE #
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NORMAL WORK DAYS AND TIMES
DATE OF HIRE
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ADDRESS ~B;ESS: STRE~
DESCRIPTION OF DUTIES O~ ~
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CITY
STATE
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WHAT DUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST
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CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT, PAGE 2
C. I certify that all of the information giyen on page one (1) of this document is true, accurate, and complete to the
knowledge. I understand that all information is subject to investigation and that falsification, omission, or misrepres
sufficient cause for disciplinary action, up to and including termination. I also understand that I am responsible for infl
supervisor in writing if any information about my outside employment changes, especially if there arises any possible
interest. Failure to do so may lead to disciplinary action, including termination of employment with the City of Miai
NAME OF;~OY(j~
EMPLOYEE ID # /13 j 0
II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
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NAME OF SUPERVISOR
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PLEASE CIRCLE ONE
DISAPPROVED
DISAPPROVED
.. I
APPROVeD
DISAPPROVED
M:\$CMB\HUMARESO\Outside EmploymerilForm.doc
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