Ramirez, Otto J.
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
Page 1 of 2
I. TO ,~ COMPLEUSQ ''( ~MPLOYEI; - This Form must be completed & approved prior to
beginning any other employment
A. INFORMATION REGARDING CITY OF NIAMIBEACH CMB EMPLOYMENT
[)EPARTMIENT , DIVISION
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HOME PHONE'
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MPI..OYEE'S OTHER PHoNE's (BEEPER. Ceil) " e t.
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To" QOM#lf.mtD Iy lM-ytaoR; OU AOIll. WITH THi
IN"OIltMATION IN nil. IlICTION? YO No
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B. INFORMATION REGARDING OUTSIDE EMPLOYMENT
'ftiP\.OYEE Ii:),
SUPIORVI$OR
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NORM~~ WORt( DAYS AND IMESI1#-1 if
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Df;$CRIPTION OF DuTIES CI) tV J1Z.C\ L ~i> tJ{J17 "YZlyi/O'1J 0 I- C-
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DEPARTMENT 'VISioN
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NAME 01' Bu$INEI!8 OR INOIVIPUA~ HIRIN~ CMS EMP\.OYEE
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WHAT DuTIE$ MIGHT lIE CONtllOIERlED TO DIE A CONI'~ICT 01' INTlEREST
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Thlt 10m has 2".,.g.. - 'be .ure to complete both pag..
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT. CONTINUED
PAGE 2 of2
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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 10 Number
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D.
By signing below, I certify that I have read this form completelv 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 in . 9 termination of my
employment with the City Of Miami Beach,
DATE
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EMPLOYEE NAME.- . () _ "7
\.J' "4L.A-M.'{~ G-'
10 NUMBER
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II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
PLEASE CIRC~E ONE
NAME OF SUPERVISOR DISAPPROVED
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NAME OF DIVISION HEAD
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P~EASE CIRC~E ONE
DISAPPROVED
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P~EASE CIRC~E ONE APPROVED
CITY ANAGER DISAPPROVED
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This form has 2 pages - be sure to c9
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