Williams, Allison R.
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
Page 1012
l. TO BE COMPLETED BY EMPLOYEE - This Form must be completed & approved prior to
beginning any other employment
A. INFORMATION REGARDING CITY OF MIAMI BEACH (CMS) EMPLOYMENT
D DEPARTMENT IOMSION
EMPlOYEE NAME: lAST NAME, FIRST NAME, MDOLE Nt\ME
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WORK A;ONE
joB TITlE
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30~. 253 - 8"4~$"
EMPlOYEE'S mER A;ONE #s ( ,CELL)
SUPERVISOR
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By,vI,4,M
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3~5. ~08. f61
To BE CoMPLETEO By : Do YOU AGREE WITH THE
INFORMATION IN THIS SEClION? YES No
NoRMAL WORK DAvs AND TIMES
MoN - R Ii: ~ - ~: 00
II'
INFORMATION REGARDING OUTSIDE EMPLOYMENT
EMPLOYEE D #
DEPARTMENT I DIVISION
,iAME OF BUSINESS OR NDIVIDUAL HIRING OJB EMPLOYEE
F10l.lDA !tJT'L VNl\lt~
WORK A;ONE #
lYPE OF BUSINESS
JOB TITlE
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SUPERVISOR
DATE ~ HIRE
NoRMAl.. WORK DAyS AND TIMES '/8/ ~
)..o\oll1OA ~ ,:50 - lo:~ ~ 5?eu.~6- 05'
ADDRESS OF 8.JSINESS: STREET
112.00 S4Al 8~ s-t
QTY
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STATE r;-t.- ZIp
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DeSCRIPTION OF D.JTIES
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.
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WHAT DuTIES MGHT BE CONSIDERED TO BEA CONFLICT OF NTEREST
NONe
This form has 2 pages - be sure to complete both pages
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT - CONTINUED
PAGE 2012
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.
Employee Name
AlliSON vJ.tll fh.U
D.
Employee 10 Number
11'131f
By signing below. I certify that I have read this form comoletely and that , do not have any other emolovment. I understand
that .tmf2aL1 start any other employment, I must reauest and obtain the above aDDroval~, 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.
/"'''''''' SaNA_
lDAtt
I_E.. .......nmE
I....LOttE NAME
I'D ro.....
II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
NAME OF SJPERVlSOR
DeNise; g tJ~M
NAMe OF DIVISION HEAD
G~c,le.. lie. H~T
NAMe OF ~PARTh1ENT ()RECTOR
yItTfH..' A lAJA' ~e.. R
OTY MANAGER
'JO~ GOI.lZ.,Pclt::z
This form has 2 pages - be sure to c
M\$CMB\HUMARESO\Outside Employment Form 10 06 03.doc
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