CITY OF PHOENIX, ARIZONA
NOTICE OF OUTSIDE EMPLOYMENT
(Refer to AR 2.62)
Employee 1.
Complete the form (refer to AR 2.62 for details). Send completed and signed form to your
department head for review.
Department 1. Review the request and determine if outside employment represents a conflict of interest or if
the hours of work will impact the employee's effectiveness on the City job.
2. Requests from middle managers or executives require recommendation of the department head
and approval of the CIty Manager's Office.
3.
After action is complete, keep the original in the department, and give a copy to the Employee.
5. JOB TITLE 6. CURRENT DATE
8.
9.
Signature of Employee
150-49D Rev. 7/08
INSTRUCTIONS:
1. EMPLOYEE NAME
7. NAME AND ADDRESS OF OUTSIDE EMPLOYER
2. DEPARTMENT/DIVISION 3. SECTION
4. EMPLOYEE ID #
10. I HAVE REVIEWED THIS REQUEST AND HAVE DETERMINED THAT IT DOES NOT REPRESENT A CONFLICT OF INTEREST.
RESTRICTIONS: (if any):
DESCRIBE YOUR OUTSIDE EMPLOYMENT DUTIES, HOURS OF WORK, AND RELATIONSHIP OF THIS WORK TO YOUR CITY JOB AND
YOUR DEPARTMENT'S ACTIVITIES. DO YOU OR THE FIRM DO ANY WORK WITH CITY DEPARTMENTS, OR REQUIRE CITY APPROVAL
OR LICENSING TO CONDUCT THIS WORK?
I CERTIFY THAT I HAVE READ AND UNDERSTAND ADMINISTRATIVE REGULATION 2.62 AND THAT THIS WORK WILL NOT INTERFERE
WITH MY CITY DUTIES AND DOES NOT CAUSE ANY CONFLICT OF INTEREST WITH MY CITY EMPLOYMENT. I UNDERSTAND THAT I
MUST INFORM MY DEPARTMENT IF MY OUTSIDE EMPLOYMENT CONDITIONS CHANGE. I UNDERSTAND THAT MY CITY JOB IS MY
PRIMARY EMPLOYMENT AND IF MY DEPARTMENT DETERMINES THAT MY OUTSIDE EMPLOYMENT IS INTERFERING WITH MY CITY
JOB, THAT I MUST STOP MY OUTSIDE EMPLOYMENT OR LEAVE MY CITY EMPLOYMENT. I ALSO UNDERSTAND THAT INJURIES
RECEIVED IN OUTSIDE EMPLOYMENT DO NOT QUALIFY FOR PAID SICK LEAVE OR CITY WORKER'S COMP. BENEFITS.
City Manager's Office Approval (only if required by A.R. 2.62)Department approval
