Sliman, Brian Inc
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. INFORMA liON REGARDING CITY OF MIAMI BEACH CMS EMPLOYMENT
10 # DEPARTMENT I DIVISI
JOB TI~
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HOME PHONE #
SUPERVISOR
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WORK PHONE #
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EMPLOYEE'S OTHER PHONE #s (BEEPER, CELL)
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NORMAL WORK DAYS AND TIMES
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To BE COMPLETED By SUPERVISOR: Do y. U AGREE WITH THE
INFORMATION IN THIS SECTION? /' YES No
B.
INFORMA liON REGARDING OUTSIDE EMPLOYMENT
EMPLOYEE 10#
DEPARTMENT I DIVISION
V\k)RK PHONE #
JOB TITLE
SUPERVISOR
NORMAL WORK DAYS AND TIMES
ADDRESS OF BUSINESS: STREET
CITY
ZIP
DESCRIPTION OF DUTIES
WHAT DUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST
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This form has 2 pages - be sure to complete both pages
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CITY~OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT - CONTINUED
'PAGE 2 of 2
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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.
E~. loyee Name
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Employee ID Number
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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.
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II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
PLEASE CIRCLE ONE APPROVED SUPERVISOR SIGNATURE & DATE
NAME OF SUPERVISOR DISAPPROVED
PLEASE CIRCLE ONE APPROVED DIVISION HEAD SIGNATURE & DATE
NAME OF DIVISION HEAD DISAPPROVED
PLEASE CIRCLE ONE APPROVED DEPARTMENT HEAD SIGNATURE & DATE
NAME OF DEPARTMENT DIRECTOR DISAPPROVED
PLEASE CIRCLE ONE APPROVED CITY MANAGER SIGNATURE & DATE
CITY MANAGER DISAPPROVED
This form has 2 pages - be sure to complete both pages
M:I$CMBIHUMARESO\Outside Employment Form 1006 OJ.doc
REV: 10106I03