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2. Employee First Name
3. Last Name
5. This is to notify of you of my participation in outside employment and/or an outside business
7. Business Name
9. Address1
11. Address2
13. City
14. State
15. Zip
17. Job Title
18. Approximate hours per week
20. Briefly describe duties
22. I certify that these activities will not interfere with my responsibility as an employee of the City of Cocoa
24. Signature*
    By typing my name in this form, I affirm the accuracy of information provided on this application. I understand that this constitutes a legal signature and confirms that I agree to the above terms.
25. Date
27. The outside employment of business will not pose a conflict with Personnel policies, Departmental policies, or Florida Statute 112.313 governing such activity
29. Department Head Signature
    I understand that this constitutes a legal signature and confirms that I agree to the above terms.
30. Date
32. Human Resources Division Signature
    I understand that this constitutes a legal signature and confirms that I agree to the above terms.
33. Date
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34. Print Only

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