Hatfield, Liliam R.
".
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
Page 1 of 2
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 (CMB ) EMPLOYMENT
ID# DEPARTMENT I DIVISION
EMPLOYEE NAME: LAST NAME, FIRST NAME, MIDDLE NAME ( S~ ). <f
HATFIELD. LILIAM R. CITY CLERK"S OFFICE
WORK PHONE # HOME PHONE #
JOB TITLE
OFFICE ASSOCIATE V X6592 305-820-0171
WORK PHONE # EMPLOYEE'S OTHER PHONE #S (BEEPER, CELL)
SUPERVISOR
Bob Parcher X6451 786-385-2247
NORMAL WORK DAYS AND TIMES To BE COMPLETED By SUPERV/SO~YOU AGREE WITH THE
INFORMATION IN THIS SECTION? YES No
M-F 8:30 a.m to 5 pm
B. INFORMATION REGARDING OUTSIDE EMPLOYMENT
EMPLOYEE ID # DEPARTMENT I DIVISION
NAME OF BUSINESS OR INDIVIDUAL HIRING CMB EMPLOYEE
SELF EMPLOYED NiA
WORK PHONE # TYPE OF BUSINESS
JOB TITLE
Transcriber.Tvuist
WORK PHONE #
SUPERVISOR
DATE OF HIRE
NORMAL WORK DAYS AND TIMES
nights & weekends
ADDRESS OF BUSINESS: STREET
6215 W. 24th Ave il10 bTY Hialeah STATE Fl liP 33016
DESCRIPTION OF DUTIES
Translating to Spanish or English, updating websites, creating power point
presentations and general word processing
WHAT DUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST
None )
~
"", . .
. . .
This form has 2 pages - be sure to complete both pages
""t'.
'-
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
Liliam R. Hatfield
Employee 10 Number
15624
7 14-06
By signing below, I certify that I have read this form completely and that I do not have any other emplovment. I understand
that before I start any other employment, I must reauest 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.
D.
7 14 06
G~~
EMPLOYEE NAME
Liliam R. Hatfield
10 NUMBER
15624
II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
NAME OF DEPARTMENT DIRECTOR
CITY MANAGER
PLEASE CIRCLE ONE
DISAPPROVED
Sn';j::Z-: 71 ~ I ~ ~
~G :It 7A t?I
DEPARTMENT HEAD SIGNATURE & DAT
(L?vf~ '(I '-11 0 l-"
NAME OF SUPERVISOR
B b Parcher
NAME OF DIVISION HEAD
Maria Martinez
Bob Parcher
Jorge M. Gonzalez
This form has 2 pages - be sure to co
M:\$CMB\HUMARESO\outside Employment Form 1006 03.doc
REV: 10/06/03