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Castell, George Stephen ~ , CITY OF MIAMI BEACH REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT Page 1 of 2 L J L I ...', '! . , ",. ,r." I. TO BE COMPLETED BY EMPLOYEE - This Form must be completed & approved prior to beginning any other employment A. INFORMATION REGARDING CITY OF MIAMI BEACH (CMSJ EMPLOYMENT 10 # DEPARTMENT I DIVISION EMPLOYEE NAME: LAST NAME, FIRST NAME, MIDDLE NAME 13627 NEIGHBORHOOD SERVICES I CODE COMPLIANCE DIVISION CASTELL,GEORGE,STEPHEN JOB TITLE - CODE COMPLIANCE OFFICER II WORK PHONE # 305-673-7000 EXT, # 6776 HOME PHONE # 954-450-9518 SUPERVISOR - JOSE ALBERTO CODE COMPLIANCE ADMINISTRATOR WORK PHONE # 305-673-7000 EXT, # 6854 EMPLOYEE'S OTHER PHONE #S (BEEPER, CELL) CELL - 3054-469-6473 NORMAL WORK DAYS AND TIMES MONDAY - FRIDAY 8:00AM - 4:30PM / To BE COMPLETED BY SUPERVISOR: Do)'Ou AGREE WITH THE INFORMATION IN THIS SECTION? / YES No B. INFORMATION REGARDING OUTSIDE EMPLOYMENT NAME OF BUSINESS OR INDIVIDUAL HIRING CMB EMPLOYEE EMPLOYEE 10 # DEPARTMENT I DIVISION S&S FORTUNE INVESTMENTS, INC, N/A N/A WORK PHONE # TYPE OF BUSINESS JOB TITLE - PRESIDENT 954-450-9518 REAL ESTATE - PURCHASE PROPERTIES, RESALES AND TAX SALES WORK PHONE # SUPERVISOR N/A N/A DATE OF HIRE NORMAL WORK DAYS AND TIMES N/A IN THE PROCESS OF SETTING UP CORPORATION, EVENINGS, NIGHTS AND WEEKENDS ADDRESS OF BUSINESS: STREET 18008 SW 30th Court CITY MIRAMAR STATE FL. ZIP 33029 DESCRIPTION OF DUTIES - Purchasing and selling properties via internet, online auctions of properties, nationwide, This is an internet business (Home based business), WHAT DUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST - None, no business to take place on Miami Beach, Working at a County, State and National Level. . '\1,- ~ ' This form has 2 pages - be sure to complete both pages 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 George S. Castell Employee 10 Number 13627 D. By signing below, I certify that I have read this form completely and that I do not ha e an other em 10 ment. 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 C' Miami Beach, EMPLOYEE NAME GEORGE S. CASTELL 10 NUMBER 13627 II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT VIV IA N GUZMAN 111I~f07 NAME OF SUPERVISOR JOSE ALBERTO NAME OF DIVISION HEAD JIMMY McMILLION NAME OF DEPARTMENT DIRECTOR PLEASE CIRCLE ON DISAPPROVED lv '01 CITY MANAGER PLEASE CIRCLE ON APPR DISAPPROVED t 1ft b This form has 2 pages - be sure to co M:\$CMB\HUMARESO\Outside Employment Form 10 06 03,doc REV: 10/06/03