Hirschhorn, Christina A.-~~l,.i ~ i~ ~;~'~~
CITY OF MIAMI BEACH ~ ~ - ~~'~~
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REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT -~- ~J --.
Page 1 of 2 - ,
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I. TO BE COMPLETED BY EMPLOYEE -This Form must be completed & approved prior to
beginning any other employment ~ -
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ID # DEPARTMENT /DIVISION
EMPLOYEE NAME: LAST NAME, FIRST NAME, MIDDLE NAME
~1I•RSCk1ki0RN ~~ CHRISTINA A 14341 CRIMINAL INVESTIGATIONS POLICE
WORK PHONE # HOME PHONE #
JOB TITLE
ADMINISTRATIVE AIDE II
X5771
(305) 534-6217
WORK PHONE # EMPLOYEES OTHER PHONE #S (BEEPER, CELL)
SUPERVISOR
SGT. PAUL MARCUS X5406 N A
TO BE COMPLETED BY SUPERVISOR: YOU AGREE WITH THE
NORMAL WORK DAYS AND TIMES INFORMATION IN THIS SECTION? YES NO
MONDAY-FRIDAY 0730-1600 HRS
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EMPLOYEEID#
DEPARTMENT/DIVISION
NAME OF BUSINESS OR INDIVIDUAL HIRING CMB EMPLOYEE ~ f`3
JER Y' N A BAKERY --~
WORK PHONE # TYPE OF BUSINESS ~ G ~"('~
JOB TITLE r^- f""' !"\
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CASHIER (305)532-8 30 DELICATESSEN ri '
WORK PHONE # ~
"C7 #/
SUPERVISOR ~
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JUSTIN (305)532-8 30 2
DATE OF HIRE ~" N
NORMAL WORK DAYS AND TIMES ~
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AEDNESDAY 1630; SAT~SUN 0700 -APPROX. 3 1'07
ADDRESS OF BUSINESS: STREET
1450 COLLINS AVEI~II~~ MIAMI BEACH STATE FL ZIP 33139
DESCRIPTION OF DUTIES
ANSWER PHONE, MAINTAIN DISPLAY WINDOWS, SELL BAKERY.
WHAT DUTIES MIGHT BE CONSIDERED TO BE A CONFLICT OF INTEREST
NOTE: THIS IS IN LIEU OF PREVIOUS APPLICATION (MDCPS), & IS T EMPORARY.
I HAVE ADVISED UNIT S OF MY HOURS , AND ENCOURAGE THEM TO CONTACT
ME WHEN NECESSARY AT THE ABOVE LOCATION AND PHONE FOR OVERTIME AS SOON
This form has 2 pages - be sure to complete potn pages
CITY OF MIAMI BEACH
REQUEST FOR APPROVAL OF OUTSIDE EMPLOYMENT -CONTINUED
PAGE 2 of 2
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 Employee ID Number mplo Ignature 8 Date
HIRSCHHORN CHRISTIN 14341 04-25-07
u.
By signing below, I certify that I have read this form completely and that I do not have anv 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.
EMPLOY SIGNATU DATE WITNESS SI RE
C' ~oS~s.~ S ~ -v 7
EMPLOYEE NAME ID NUMBER
HiRSCHHORN CHRISTINA A 14341
II. TO BE COMPLETED BY EMPLOYEE'S CITY OF MIAMI BEACH DEPARTMENT
PLEASE CIRCLE ON PPROVED SUPERVISOR SIGNATURE & DATE
NAME OF SUPERVISOR DISA
P
PROVED
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PLEASE CIRCLE O E APPROVED DIVISION HEAD SIGNATURE 8 DATE
NAME OF DIVISION HEAD DISAPPROVED ~-
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PLEASE CIRCLE ONE PPROVED DEPARTMENT HEAD SIGN RE & DATE
NAME OF DEPARTMENT DIRECTOR DISAPPROVED
PLEASE CIRCLE ON APPROVED CITY MANAGER SIGNATURE DATE
CITY MANAGER DISAPPROVED
D~Ern, G~o~ ~~z
phis form has 2 pages - be sure to g~mplet~b~th pages
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