Phillips, Steven Michael (2)
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CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT
Page 1 of 2
I. TQ 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
10 # OEPARTMENT I OIVISION
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D BY SUPERVISOR: Do YOU AGREE WITH ntE
INFORMATION IN ntlS SECTION? YES NO
B.
INFORMATION REGARDING OUTSIDE EMPLOYMENT
EMPLOYEE 10 #
OEPARTMENT I DIVISION
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DESCRIPTION, r OUTIES
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WHAT OUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST ILl W.e;
This form has 2 pages - be sure to complete both pages
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT - CONnNUED
PAGE 20f2
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.
D.
I~EN_
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By signing below, I certify that I have read this form comoletely and that I do not have any other emolovment. I understand
that before I start any other employment, I must reauest and obtain the above aDorovals, 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
NAME OF SUPERVISOR
PLEASE CIRCLE ONE APPROVED
DISAPPROVED
SUPERVISOR SIGNATURE & DATE
NAME OF OIVISION HEAD
PLEASE CIRCLE 0
DISAPPROVED
PROVED
NAME OF OEPARTMENT DIRECTOR
PLEASE CIRClE 0
DISAPPROVED
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