PF-501 THE CITY OF PENSACOLA ©
RECOMMENDATION FOR PERSONNEL ACTION
Ta] Sisson EDWARD BT OO UF GO
>| BR CHIEF OFFICER
iowoIS
Department Director Date Wayor/Designee (when applicable) Date
bi _a.[r//e
Human Resources Chief Officer Date Human Resources Reviewer !~ Date
Revised 10/2014 Edward Sisson
Monday, March 07, 2016 9:48 AM
Adriana Van Landingham; Angela Channell; Cheryl Jackson
Tracy Walsh
Address Change - Edward 3-10-16
Please note that as of 3-10-16 my address will change to the following:
Please move forward in generating the PA to effectuate the change. Thanks!
Edward
Edward F. Sisson, SHRM-SCP, SPHR, CEBS
Chief Human Resources Officer
City of Pensacola
222 W Main Street — City Hall
Human Resources Office ~ 4° FL
Pensacola, FL32521
Office — 850-435-1727
Fax ~ 850-595-1298
N
ice: Florida has a very broad public records law. Most written communications 10 a fram state and local officals regarding government
iness are public records available ¢o the public and media upon request. Yous email communications may be subject to publie disclosure. PF-501 THE CITY OF PENSACOLA ©
RECOMMENDATION FOR PERSONNEL ACTION
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Department Director Date Wayox/Designes (when applicable) Date
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Human Resources Director Date Human Resources Reviewer Date
Revised 1/2011 Edward Sisson
Wednesday, April 22, 2015 3:14 PM
Adriana Van Landingham.
Tracy Walsh; Cheryl Jackson
Subject: Change of Address
am moving this weekend and need to get my address updated on all City records as well as with Nationwide.
New address i
Please let me know if you have any questions and thank you in advance for your time and assistance.
Edward
Edward F. Sisson, SPHR, CEBS
Chief Human Resources Officer
City of Pensacola, Florida
PH : 850-435-1727
Fax: 850-595-1298
isson@cityofyensacola.com
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q RECOMMENDATION FOR PERSONNEL ACTION
D0ISeO
Edward F
ison
| Human Resources
Human Resources gn Resource
062 605000 0272015
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c-04 c=04
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‘See attached memorandum.
lie
(see_atichel sens)
Di: oo. nistrator Date Mayor/D. eA (when any Date
A958 Comedie? ZOSIS
Human Resources Administrator Date Human Resoufces Reviewer
Revised 08/2013 MEMORANDUM
To: ‘Tamara Fountain, Chief Operations Officer yw
FROM: Edward Sisson, Human Resources Administrator bo 5
geil
DATE: February 9, 2015
SUBJECT: Annual Review - Request for Title Change and Compensation Adjustment
February 3, 2015 marked my one year anniversary as the Human Resources Administrator for the City.
During the past year, I have worked diligently to ensure the needs of my customers (both intemal and
external) have been met and/or exceeded. I continue to shape the Human Resources Office and related staff
into being reliable and proactive business partners for our various departmentsloffices. I have identified
needs and services that our office should be providing in support of the Administration and as a resource to
‘our management team, Ihave undertaken a number of projects and tasks as well as looking to revise,
eliminate, and develop policies and procedures for the betterment of the City some of which include:
‘© Audit and classification studies for the Clerk’s Office, Sanitation Services, Pensacola Energy,
Inspection Services, the Planning Office, and the Port.
‘Revamping the Employee Recognition Program.
‘+ Developing and implementing a training program for our employees on # number of topics relevant to
‘our operations. This is an on-going effort and will continue to grow.
‘* Redesigned the City’s approach to New Employee Orientation, to include contact prior to as well as
follow up weeks after cach employees’ start date to reinforcement their decision to join our team.
‘Assessed our Applicant Tracking System, researched alternative solutions, and found and
implemented a more user friendly system while also securing clectronic on-boarding and
performance management modules which are geared towards a pay for performance type of
compensation strategy.
‘Reduced and eliminated unnecessary steps in the hiring practices our of Public Safety employees.
* Conducted recruitment efforts for several executive level positions as well as reaching out into the
‘community to identify altemative options for succession planning,
‘+ Established excellent business relationships with local staffing agencies as needed to meet staffing
eds in short and sometimes no prior notice circumstances.
Established business relationships with local schools and universities for purposes of recruitment.
* Successfully negotiated several grievances and executed MOUs with different collective bargaining
units, as well as on-going efforts with the IAFF to secure a deal.
# Successfully removed, and/or helped to remove, individuals from our organizations that did not add
value (at all levels).
‘+ Identified more cost efficient, and in some case no cost, options to source applicants for positions at
all level in the organization (City Attorney, Airport Director, CIO, ete.)
‘* Partnered with Technology Resources to create a computer lab for City Hall for purposes of actively
teaching our staff « number of electronic skills, as well as use for other future needs that can be
incorporated such as electronic benefits enrollment,
«Identified problems with the City’s background check processes/provider and have researched and
implemented a much more accurate and thorough process to mect our need to include changing the
City to being an active participant with E-Verify.
‘+ Worked with Technology Resources to update the Human Resources Intra-net Website (this task
remains unfinished currently),
‘+ Established and am currently working to provide professional clessification and compensation work
to be completed as a service offered by our office. As you are aware, there are numerous other projects that Thave worked to see through completion from
construction, building redesign, and security to employee health and welfare issues all in hopes of helping
make Pensacola the best place to live, work, and play.
Thave been a huge advocate for trying to eliminate the “because it is how we have always done it” mentality
within our organization and to illustrate through my own actions that there are better and more innovative
ways of meeting the needs of our customers (be it my ideas or from the recommendations of others). All of
the items mentioned above help illustrate testament to my dedication to the Administration and the betterment
of the City. [believe my actions and initiatives also deliver ata service level above and beyond the more
recent predecessors that served in my capacity as I seck not just to achieve excellent operations on a day by
day basis, but look to strategically plan for tomorrow,
For these reasons, I am requesting consideration for a salary adjustment as well as a title change to Chief
Human Resources Officer (CHRO). I off the following statistical data, as a supplement to the information
‘mentioned earlier, in support of a compensation adjustment above my current rate of $87,500 annually:
‘Prior incumbents in my role either retired or separated service from the City at annual salaries of
roughly $95,000 and $99,000 respectively with both having more staff to complete tasks,
researched a number of comparable positions (at the level of Human Resources Administrator) with
other organizations which include:
City of Gainesville, FL - $119,541.67 annvally
oCity of Sarasota, FL - $118,664 amually
oCity of Ocala, FLL - $92,920 annually
City of Lakeland, FL - $116,730 annually
oCity of Naples, FL - $115,751 annually
oCity of North Port, FL. - $121,866 annually
2007-2010 Current Population Survey for the U.S, Census and Center for Florida Local Govemment
Excellence calculated a state average of $98,666 for total compensation for managers of a public,
employer.
Given all the information provided, I respectfully request your consideration and approval for a salary
adjustment to $99,700 to be effective February 2, 2015 as well as a ttle change to Chief Human Resources
Officer. This change in compensation does not exceed the maximum of the pay grade assigned to my
position,
Tthank you for the opportunity you provide in allowing me to serve in my capacity and look forward to many
more years as a strategic member of the City’s Executive team. Payroll Calculator
Annual Salary Conversion to Hourly Rate
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47.93 3634.40 99,694.40]
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civil service and contract. Use appropriate payroll calculator. MEMO,
TO: Edward F. Sisson
FROM: Ashton J. Hayward Ill, Mayor
DATE: February 2, 2015
SUBJECT: Notification of Employee Contract Change
Addendum to Contract
Your employee contract is hereby amended to read:
Effective February 2, 2015, the title for Edward F, Sisson, has been
changed from Human Resources Administrator to Chief Human
Resources Officer.
All other provisions in your contract will remain in full force and effect.
Any sections of the administrative contract that should be found to be
in conflict with this amendment are hereby declared null and void
This addendum will be attached to your original contract, which is on
file in the Human Resource Office. REQUEST FOR BUDGET TRANSFER
DEPARTMENT ACTIVITY
Human Resources
TRANSFER TO: ow
Account No. Amount
OM: SEE BELOW
Account No. Amount
JUSTIFICATION OF REQUEST (Be Specific)
Change title of one (1) Human Resources Administrator (C-04 PCN #1135-001)
to Chief Human Resources Officer (C-04 PCN #1136-001); 02/1/15.
BUDGET COMMENTS: — (
APPROVED
DISAPPROVED DATE:
Lg
ALLEYS APPROVED:
DATE City AbMINIST: DEPARTMENT
Submit One (1) copy to Budget Office. MEMO,
TO: Edward F. Sisson
FROM: Ashton J. Hayward Ill, Mayor
DATE: February 2, 2015
SUBJECT: Notification of Employee Contract Change
Addendum to Contract
Your employee contract is hereby amended to read:
Effective February 2, 2015, the title for Edward F. Sisson, has been
changed from Human Resources Administrator to Chief Human
Resources Officer.
All other provisions in your contract will remain in full force and effect.
Any sections of the administrative contract that should be found to be
in conflict with this amendment are hereby declared null and void.
This addendum will be attached to your original contract, which is on
file in the Human Resource Office. 5
PE-501 THE CITY OF PENSACOLA
: RECOMMENDATION FOR PERSONNEL ACTION
- 7 Tapleyeor deibe
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Date Adriana Van Landingham
Edward Sisson
Wednesday, May 28, 2014 9:22 AM
‘Adriana Van Landingham
‘Cheryl Jackson; Angela Channel!
‘Address Change - Edward Sisson
Good Morning Ladies,
Please update my City profile (FRS, benefits, payroll, etc.) to reflect the following:
Thank you.
Edward F, Sisson, SPHR, CEBS
Human Resource Administrator
City of Pensacola, Florida
PH : 850-435-1727
Fax: 850-595-1298
ESisson@eityofper
Notice: Florida has a very Broad put
business are public recor available to
records low. Most written communications to or fiom state and locel oficial regarding government
he publi ond media upon request. Your email coramwnications may be subject to public disclosure, PF~502
THE CITY OF PENSACOLA
RECOMMENDATION FOR PERSONNEL ACTION
Effective Date
APPOIN'
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2/3/2014
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Hourly Rate $42.06 I Bi-Weekly | $3,364.80 ‘Annual, Salary $87,484.80.
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vl service and contract. Use appropriate payroll calulator. THE UPSIDE of FLORIDA
OPFICE of thy MAYOR
January 10, 2014
Mr. Edward Sisson
Dear Mr. Sisson:
‘On behalf of the Mayor, this letter formally offers you the position of Human Resources
Administrator with the City of Pensacola, contingent on your passing the City’s Employment
Medical Examination and drug screen. Please contact the clinic at (850} 435-1664 to schedule the
examination, which will be conducted at Baptist Occupational Health Clinic, 9400 University
Parkway, Pensacola, Florida, 32514. The City will consider reasonable accommodation of any
impairing condition, on a case-by-case basis, depending upon the circumstances.
You'll be asked to sign a contractual agreement with Mayor Hayward, who has approved your
starting salary at $87,500 annually, paid bi-weekly. During your first week of work, you will receive
a packet of information which will describe City benefits. This, along with City procedures and
policies, will be explained in detail during your orientation meeting. These benefits include
coverage by the Florida Retirement System (FRS) with a state-required employee contribution of
3% of FRS covered pay.
Because the City of Pensacola participates in the Florida Retirement System (FRS), the enclosed FRS
form is required to be completed and returned. The form explains that if you are retired from a
State of Florida administered retirement plan, your benefits could be severely impacted by
reemployment with a covered employer such as the City of Pensacola.
Please notify this office of your decision and provide us a proposed date to begin work.
Sincerely,
Lilla Ky CsbOE
Colleen Castille
City Administrator
THAT'S GREAT ABOUT FLORIDA IS BETTER IN PENSACOLA,
ct Pensocala, FL 32502/T: 850.435.1426 /wwweltyolp EMPLOYMENT AGREEMENT
STATE OF FLORIDA )
COUNTY OF ESCAMBIA)
THIS AGREEMENT, made and entered into this 3° day of February, 2014, by and between
the Mayor of the City of Pensacola, Florida, hereinafter referred to as “Mayor”, and EDWARD F.
SISSON hereinafter referred to as ‘The Employee”, both of whom understand as follows:
WITNESSETH:
WHEREAS, the Mayor desires to employ the services of EDWARD F. SISSON and
WHEREAS. it is the desire of the Mayor to provide certain benefits, to establish certain
conditions of employment and to set working conditions of The Employee; and
WHEREAS, it is the desire of the Mayor to (1) secure and retain the services of The
Employee and to provide inducement for him to remain in such employment, (2) to make possible
full work productivity by assuring The Employee's morale and peace of mind with respect to future
seourity, (3) to act as a deterrent against malfeasance or dishonesty for personal gain on the part
of the Employee, and (4) to provide a just means for terminating The Employee's services at such
time as he may be unable to fully discharge his duties due to disability, or when Mayor may desire
to otherwise terminate his employment; and
WHEREAS, The Employee desires to accept employment as HUMAN RESOURCES
ADMINISTRATOR of said City;
NOW, THEREFORE, in consideration of the mutual covenants herein contained, the
parties hereby agree as follows:
SECTION 1. Duties. Mayor hereby agrees to employ EDWARD F. SISSON to perform
such duties and functions as specified from time to time by the Mayor.
SECTION 2. Termand Removal. This contract shall commence on February 3, 2014 and
remain in effect until termination by Mayor or resignation by The Employee; provided, however,
that The Employee may voluntarily resign at any time and The Employee may be terminated at
the sole discretion of the Mayor, subject to the provisions of Section 6 as stated herein. This
contractual employment relationship shall be construed, as one, which is terminable at will by
either party. No provision of this contract shall be deemed by either party to confer a
constitutionally protected property right upon The Employee, and The Employee expressly
acknowledges that the benefits provided by this contract constitute the total City of Pensacola
benefits accorded by the employment relationship and that there is no reasonable expectation of
Page 1 of 3 continued employment upon any term or condition not stated herein. The Employee expressly
acknowledges that the provisions of this contract do not provide The Employee with entitlement to
a pre-termination hearing or any procedural or substantive benefit other than those expressly set
forth in this contract.
SECTION 3. Salary and Retirement Program.
A. The salary range for The Employee shall be that as set forth in the Administrative
Pay Plan as established by the City Council for all professional non-civil service appointed
Employees of the City as the same may be amended from time to time. The salary for The
Employee within this range shall be that amount periodically established by the Mayor. The salary
for The Employee is payable periodically at the same time as other Employees of the City are
paid.
B. As provided for by law, The Employee shall be entitled to complete balances in all
defined contribution plans held in The Employee's name as established by the City.
SECTION 4. Hours of Work. The hours of work for The Employee shall be established and
are subject to change at the discretion of the Mayor. Although the Mayor may, in his discretion,
provide remuneration or other benefit in regard to the number of hours The Employee renders
service under this contract, it is hereby acknowledged that the services to be rendered under this
contract are regarded as exempt under the overtime provisions of the Fair Labor Standards Act
(FLSA), unless otherwise stated.
SECTION 5, Other Terms and Conditions.
A. The Mayor shall fix any other terms and conditions of employment, as from time to
time determined, relating to the performance of The Employee, provided such terms and
conditions are not inconsistent with or in conflict with the provisions of this agreement, the City
Charter, or any other law.
B. _Allprovisions of the City Code, and regulations and rules of City relating to personal
time off leave (PTO), holidays, and other fringe benefits and working conditions as they
now exist or hereafter may be amended, shall also apply to The Employee as they would to.
other Employees of the City with the exception that The Employee shall be credited
eighteen (18) hours of paid time off a month, On each January 1, The Employee may
have a maximum accumulation of 500 hours of PTO leave, The Employee may accumulate
more PTO leave time during the calendar year, without limitation, but in no case shall there
be more than 500 hours of PTO leave accrued on any given January 1 of a calendar year.
On the first day of the pay period beginning in January of each year, the employee's PTO
balance shall be reduced to the allowed maximum of 500 hours. These excess hours will
be place in an SEMLA account. The Employee will be able to use this leave for FMLA
qualifying absences or may donate this leave. The Employee may not be paid for any
hours remaining in this auxiliary PTO account upon leaving City employment.
Page 2 of 3 SECTION 6. Termination, Notice and Severance Pay
A. The Mayor shall have the right to cancel and terminate this Employment Agreement
with The Employee at any time, in the discretion of the Mayor. In addition, the Mayor shall have
the option, at his sole discretion, to offer The Employee whose contract is being terminated the
opportunity to execute 2 Waiver, waiving any right The Employee may have to file a complaint,
appeal, lawsuit, or other challenge against the City of Pensacola or its officers, agents, or the
Employees, in exchange for the payment of ninety (90) days' severance pay, which payment may
be made on regularly scheduled pay days or in a lump sum payment, at the discretion of the
Mayor. Severance pay is calculated by dividing 90 days by 360 and then muttiplying that amount
by The Employee's annual salary. If The Employee is not offered an opportunity to exeoute a
Waiver or who declines to do so if an opportunity is offered, shall receive thirty (30) days’
severance pay. Any severance pay paid pursuant to this Employment Agreement shall be net of
any lawful withholdings.
B. Provided however, that in the event The Employee is terminated because of his
conviction in the trial court of any felony or any employment related misdemeanor of the first
degree, then in that event, the Mayor has no obligation to give notice or pay the aggregate
severance sum designated in this paragraph.
IN WITNESS WHEREOF, the Mayor of the City of Pensacola, Florida, and The Employee
have signed and executed the Employee Agreement, in duplicate, this =? /9/ig :
2014,
Attest:
Sucka X Buuanctte 2:7: 20/¢
ity Clerk . AM, i
City of Pertsacola
Dee
Edward F. Sisson
(Seal)
Page 3 of 3 OFFICE of sh
MEMORANDUM
To: Edward Sisson, HR cated
From: Erie Olson, City Administrator 2222
Date: April 29, 2015
Subj: Appointment as Title VI Coordinator
Ref: (a) Title VI of the Civil Rights Act of 1964,
Attach: (a) Appendix A to Title VI/ Nondiscrimination Assurance
(2) Title VI/Nondiscrimination Assurance
1, Pursuant to reference (a), you are hereby appointed as Title VI Coordinator for the City
of Pensacola.
2. You are to perform your duties in accordance with reference (a) and any amplifying
instructions provided by the Florida Department of Transportation (FDOT), see
attachments (1) and (2). Any need for direction or clarification should be brought to the
attention of the City Administrator for appropriate action.
ce: Ashton J. Hayward, III, Mayor
Dick Barker, Jr., Chief Financial Officer
Tamara Fountain, Chief Operations Officer
5 BETTER IN PENSACOLA, APPENDIX ATO TITLE VI/ NONDISCRIMINATION ASSURANCE
City of Pensacola
Florida Policy Statement for Title VI
The City of Pensacola declares that it will not tolerate discrimination. That it will uphold all
requirements and regulations of the Florida Department of Transportation, The Federal Highway
‘Administration, the Federal Transit Authority as well asthe United States Department of Transportation
and the United States Government. The City of Pensacola abides by the requirements of Title VL of the
Civil Rights Act of 1964 based on law, equality, morality and the desire to do what is right for our
entire community
o A he
Ue Land ? sbyser
‘Ashton 1. Hayward, 11], Mayor Edward F.
ison, Title VI Coordinator ENOIK B TO TITLE VU NONDISCRIMINATION ASSURANCE
REQUIRED CONTRACT CLAUSES
During the performance of this contract, the contractor, for itself, its assignees and successors in
interest (hereinafter referred to as the Contractor’) agrees as follows:
(1.) Compliance with Regulations: The Contractor shall comply with the Regulations relative to
rnondiscrimination in Federally-assisted programs of the U.S. Department of Transportation
(hereinatter, ‘USDOT") Title 49, Code of Federal Regulations, Part 21, as they may be
‘amended from time to time, (hereinafter referred to as the Regulations), which are herein
incorporated by reference and made a part of this Agreement.
(2) Nondiscrimination: The Contractor, with regard to the work performed during the contract,
shall not discriminate on the basis of race, color, national origin, sex, age, disability, religion
of family status In the selection and retention of subcontractors, including procurements of
materials and leases of equipment. The Contractor shall not participate either directly or
indirectly in the discrimination prohibited by section 21.5 of the Regulations, including
‘employment practices when the contract covers @ program set forth in Appendix B of the
Regulations,
(3) Solicitations for Subcontractors, including Procurements of Materials and Equipment:
In al solicitations made by the Contractor, either by competitive bidding or negotiation for
work to be performed under 2 subcontract, including procurements of materials or leases of
‘equipment: each potential subcontractor or supplier shail be notified by the Contractor of the
Contractor's obligations under this contract and the Regulations relative to nondiscrimination
‘on the basis of race, color, national origin, sex, age, disabilty, religion or family status.
(4.) Information and Reports: The Contractor shail provide ail information and reports required
by the Regulations or directives issued pursuant thereto, and shall permit access to its books,
records, accounts, other sources of information, and its facilities as may be determined by the
Florida Department of Transportation, the Federal Highway Administration, Federal Transit
‘Administration, Federal Aviation Administration, and/or the Federal Motor Carrier Safety
‘Administration to be pertinent to ascertain compliance with such Regulations, orders and
instructions. Where any information required of a Contractor Is in the exclusive possession of,
another who fails or refuses to furnish this information the Contractor shall so certify to the
Florida Department of Transportation, the Fodoral Highway Administration, Federal Transit
Administration, Federal Aviation Administration, and/or the Federal Motor Carrier Safoly
Administration 2s appropriate, and shall set forth what efforts it has made to obtain the
information,
(6. Sanctions for Noncompliance: In the event of the Contractor's noncompliance with the
ondiscrimination provisions of this contract, the Florida Department of Transportation shall
impose such contract sanctions 2s it or the Federal Highway Administration, Federal Transit
Administration, Federal Aviation Administration, and/or the Federal Motor Camer Safely
‘Administration may determine to be appropriate, including, but not limited to:
2. withholding of payments to the Contractor under the contract until the Contractor
complies, andor
bb. cancellation, termination or suspension of the contract, in whole or in part
(6) Incorporation of Provisions: The Contractor shail include the provisions of paragraphs (1)
through (8) in every subcontract, including procurements of materials and leases of
‘equipment, unless exempt by the Regulations, or directives issued pursuant thereto. The
Contractor shall take such action with respect to any subcontract or procurement as the [APPENDIX 8 TO TITLE W NONOISCRIMINATION ASSURANCE
Florida Department of Transportation, the Federal Highway Administration, Federal Transit
‘Administration, Federal Aviation Administration, and/or the Federel Motor Carrier Safety
Administration may direct as @ means of enforcing such provisions including sanctions for
noncompliance. In the event a Contractor becomes involved in, or is threatened with,
itigation with a sub-contractor or supplier as a result of such direction, the Contractor may
request the Florida Department of Transportation to enter into such Itigation to protect the
interests of the Florida Department of Transportation, and, in addition, the Contractor may
request the United States to enter into such litigation to protect the interests of the United
States Attachment 2
TITLE VI/ NONDISCRIMINATION ASSURANCE
Pursuant to Section 9 of US DOT Order 1050.2A, the City of Pensacola assures
the Florida Department of Transportation (FDOT) that no person shall on the basis
of race, color, national origin, sex, age, disability, family or religious status, as
provided by Title VI of the Civil Rights Act of 1964, the Civil Rights Restoration Act
of 1987, the Florida Civil Rights Act of 1992 and other nondiscrimination
authorities be excluded from patticipation in, be denied the benefits of, or be
otherwise subjected to discrimination or retaliation under any program or activity.
The City of Pensacola further assures FDOT that it will undertake the following
with respect to its programs and activities:
1. Designate a Title VI Coordinator that has a responsible position within the
organization and access to the City Administrator.
2. Issue a policy statement signed by the City Administrator (Appendix A of
this assurance), which expresses its commitment to the nondiscrimination
provisions of Title VI, The policy statement shall be circulated throughout
the City’s organization and to-the general public. Such information shall be
published where appropriate in languages other than English.
3. Insert the required contract clauses attached hereto in Appendix B of this
assurance in every contract subject to the Acts and the Regulations.
4, Develop a complaint process and attempt to resolve complaints of
discrimination against sub-recipients.
5. Participate in training offered on Title Vi and other nondiscrimination
requirements.
6. If reviewed by FDOT or USDOT, take affirmative action to correct any
deficiencies found within a reasonable time period, not to exceed ninety
(90) calendar days.
7. Have a process to collect racial and ethnic data on persons impacted by
City programs.
THIS ASSURANCE is given in consideration of and for the purpose of
obtaining any and all federal funds, grants, loans, contracts, properties,
discounts or other federal financial assistance under all programs and activities
and is binding, The person whose signature appears below is authorized to
sign this assurance on behalf of the City of Pensacola.
Dated Keae 2F 201k
ih)
‘Ashton J. Hayward Ill, Mayor
by
Revised 04/2015 Tony Biosca i.
Edward Sisson
Tuesday, January 20, 2015 3:09 PM
Tony Biosca
FW: Congratulations on earning CEBS CPE Compliant Status
Please scan this entire email to my personnel file. Thank you.
Edward F. Sisson, SPHR, CEBS
Human Resource Administrator
ity of Pensacola, Florida
PH : 850-435-1727
Fax: 850-595-1298
ESisson@cityofpensacola.com
PENSACOLA
DIAL 311 FOR CITY SERVICES
Notice: Florida has a very broad puble records law. Most written communications to or from state and local officals regarding government
business are public records available to the public and media upon request. Your email communications may be subject to public disclosure.
From: Tamara Fountain
Sent: Tuesday, January 20, 2015 3:07 PM
To: Edward Sisson
Subject: RE: Congratulations on earning CESS CPE Compliant Status
Well, you are a total rockstar
Sent: Tuesday, January 20, 2015 2:57 PM
To: Tamara Fountain
Ce: Dick Barker Jr
Subject: FW: Congratulations on earning CEBS CPE Compliant Status
Tamara,
‘This past year was the first year that the International Society of Certified Employee Benefits Specialists required “re-
certification” for one of the certifications (CEBS) | had earned in the past. | wanted to forward you this email to illustrate
my continued compliance, commitment, and as an acknowledgement of my continued efforts to grow professionally as
a resource for the City
Edward F. Sisson, SPHR, CEBS
Human Resource Administrator
City of Pensacola, Florida
PH : 850-435-1727
Fax: 850-595-1298
con @cityofpensacola.com DENISAC gy A
OMA hf
DIAL 711 FOR CITY SERVICES.
Notice: Florida has a very broad public records law. Most written communications to or fiom state and local officials regarding government
business are public records available to the public and media upon request. Your email communications may be subject to public disclosure,
From: Edward Sisson [mailto:edwardfsisson il.corn]
Sent: Tuesday, January 20, 2015 1:42 PM
To: Edward Sisson
‘Subject: Fwd: Congratulations on earning CEBS CPE Compliant Status
Begin forwarded message:
"CEBS"
January 20, 2015 at 1:06:41 PM CST
‘To: edwardfsisson@hotmail.com
Subject: Congratulations on earning CEBS CPE Compliant Status
Reply-To: CEBSCpe@ifebp.org,
Problem viewing tis emai? Ck here er our online version.
Congratulations ~ You've Done It!
Dear Edward: (On behalf of the Certified Employee Benefit Specialist (CEBS) program, we are pleased to
confirm that you have satisfied the continuing professional education requirements to be
considered CPE-compliant for the 2015-2016 reporting period.
Participation in the CPE program serves as a visible acknowledgement of your commitment to
professional growth essential to the plan(s) you serve. CPE-compliant CEBS designees are
leaders, champions of change and at the forefront of a dynamic industry, serving both theit
organizations and the profession
You've done the work, now its time to let everyone know! Your name is listed on the
compliance website. You are welcome and encouraged to hishlight your compliant status on
‘your business cards, online profiles or other professional platforms. In addition. a certificate
highlighting your compliant status will be available via your International Foundation profile in
early February, using the same login you do to report your credits. You will also have the
option of printing a letter to send to your employer highlighting your accomplishment.
‘The CPE program serves to recognize and value your commitment to your professional
development and applying the highest standards to your career. Your contribution to the
profession's collective knowledge keeps the CEBS designation strong for all who earn It,
(Once again, congratulations.
Sincerely,
andia L Puke
‘Sandra L, Becker, CEBS
Director CEBS/ISCEBS
06600
‘ft any tine you wish ta be ramaved ro the Irtemational Foundation's © dsrtbution Ht
you can ungubstrae fo this mang, oF uptat the communication section of your profs,
s¥yeutave any questions. losse contac the CESS Deparment a 809} 440-2327, option 3; or ema copseneitepn om.
Intemational Foundation of Employee Benoit Plans—CeBS
18700 W. Blsemaurd Rd, P.O. Bex 1270, Brkt, Wi 69008-1270
isis ontie wat
Paracy paey
Powered by Informz Ss PF 360
Position: Human Resources
Administrator
Department: Human Resources
CITY OF PENSACOLA
MEDICAL QUALIFICATION NOTICE
Edward Sisson has passed his employment examination for employment
with the City of Pensacola.
Comment:
we
Signed: Ramon Ryan, M.D./ Kristy Wilson, R.N.
Date: 2/3/2014 EMPLOYEE QUESTIONAIRE
In order to keep current and accurate employee information, we would like
each employee to complete the following questionnaire,
Tee
Name Ed LF. Sssan
Address.
|
Sex L Nickname.
Race.
Classification Title
Resouree ® Division
City
Social Security
Date of Birth,
Department Hum
Highest Grade Completed (please circle one) 12345678910
11:12:13 14 13 6
tvalstiorienialoniemployes quastonnaie PF-405 Submit one copy
OUTSIDE EMPLOYMENT FORM
vom Edel f Seana
tootite Human Pessurces Mwaistolo~ veperment Hettan Rescures
Outside Employer ‘Type of Business
Date Employed Immediate Supervisor.
Duties
Hours (time of day) and days worked.
‘Average hours worked per week
Is there ANY way in which this employment might lessen your efficiency in performing your City job due
to lack of sleep, strenuous work, etc.?
Yes__No if Yes, please explai
Comments (by employee or supervisor)
Thereby swear all staternents have been made fully and accurately. 1 will give immediate notification
upon termination of the above employment on "Termination of Outside Employment" form (PF-406).
21 2-H-H
Employee's Signature Date
Approved
‘Activity Head ___ Not Approved
‘Approved
Department Director Not approved
Provide this copy to Human Resources for filing in the employee's personnel file. a
PLEASE SIGN THE FOLLOWING ACKNOWLEDGEMENT
RETURN TO HUMAN RESOURCES
THIS WILL BE PLACED IN YOUR PERSONNEL FILE
City of Pensacola
Vehicle Use Agreement
| acknowledge that I have received a copy of the Vehicle Use Policy and that |
have read the policy and understand my rights, responsibilities and agree to abide
by the provisions contained therein. | understand that any special circumstance
requiring deviation from this policy must be requested in writing and approved by the
Mayor/Designee or Department Director/Administrator before making such deviation.
llund E S;550n
PRINT NAME: Authorized Employee Driver
Aur 2 Neo 2-H
SIGNATURE: Authorized Employee Driver Date
8/2013 DRUG TESTING CONSENT, RELEASE AND
ACKNOWLEDGEMENT OF UNDERSTANDING
Thereby consent to submit to urinalysis and/or other tests as shall be determined
thereof by the City of Pensacola as a condition of employment and for the purpose of
determining specific drug content. I agree that a D.FLH.S. and (state where required)
certified lab may collect these specimens for these tests and may use them or forward
them to a testing laboratory designated by the City of Pensacola for analysis.
| further agree to have these results reviewed by a Medical Review Officer. I
hereby release to the City of Pensacola, the results of the test(s) to which I have
consented. I further authorize the City of Pensacola to discuss the results with
medical/personnel collecting the Specimen, the testing facility, it's directors, officers,
agents, and employces responsible for administering the aforementioned test(s) or
‘evaluating the results thereof and any of them herein and to use the test results in
conjunction with employment actions, professional licensing procedures, and as a defense
to any legal action to which I am party. Trelease any testing facility or any physicians
who have tested me from any liability arising from a release of any and all results, written
reports, medical records, and data concerning my test(s) to the appropriate company
officials or government agencies. T agree that a reproduced copy of this form shall have
the same effect as the original.
T understand the City of Pensacola’s Drug Abuse and Drug Testing Policy and
consent to the terms set forth in the policy. I further acknowledge that the policy has been
posted in an appropriate place on the company’s premises and copies are available for
inspection during regular business hours. I acknowledge that I have read this policy and
fully understand that the City of Pensacola can establish other work rules related to
possession, use, sale or solicitation of drugs, including policies concerning arrests or
convictions for drug or alcohol-related offenses, and can suspend, or terminate, or deny
employment for such conduct,
Thave carefully read the foregoing and fully understand its contents. I agree that
my signing of this Consent, Release and Acknowledgement of Understanding form is
voluntary and that I have not been coerced into signing this document.
ae
Printed Eland E, Sisson WORKERS' COMPENSATION POLICY
ACKNOWLEDGEMENT FORM
This form acknowledges the receipt and understanding of the Drug Free Workplace
Policy. Our Department is a drug-free workplace for the benefit of all employees,
customers and the business entity. State law provides for the possible denial of workers’
compensation benefits for employees’ who are injured while working and subsequently
test positive. The use of illegal drugs will not be tolerated or subsidized.
‘The following drugs are among those that may be tested under our Drug Free Workplace
Policy:
Amphetamines _Barbiturates
Cannabinoids Benzodiazepines
Cocaine Methadone
Opiates Propoxyphene
Pheneyclidine
‘There are multiple sub-families of individual drugs under the D.H.H.S. requirements.
‘These are known by many names. As adults we all know itis ill-advised for anyone to
take pills or medication that have not been prescribed by a physician. Improper use of
prescription medication can place you in a position of forfeiting your job, workers!
compensation benefits and unemployment benefits as well.
Do not misuse prescribed, non-prescribed or over-the-counter medication; do not use
illegal drugs or misuse aleohol. The Company has a written policy on drug abuse. It is
posted and available to you to read, understand and follow. It is your responsibility to
know the provisions of this policy.
SUMMARY STATEMENT:
The State workers’ compensation laws and administrative rules are published and are
available in public libraries. Employees can write to the State Department of Financial
Services, Division of Workers! Compensation for detailed information,
et ued oP Jie DATE, le 20-14 AUTHORIZATION FOR LIMITED USE OR
DISCLOSURE OF MEDICAL INFORMATION
EXPLANATION:
This authorization for use or disclosure of medical information is requested of you to
‘ensure the accuracy, confidentiality, and prompt availability of said information,
AUTHORIZATION:
Thereby authorize the Medical Review Officer, any counselor or treatment facility Imay
be referred to and the testing laboratories to furnish the City of Pensacola, with results of
all tests run, I further authorize any doctor who has written a prescription which I may be
using to disclose the purpose of the prescription, the conditions under which it is to be
taken, and any other pertinent information to the Medical Review Officer to assist in the
MRO's determination of my fitness for duty,
USES:
The City of Pensacola may use the medical information authorized only for the following
purpose: To determine my ability to do my job or my qualifications for employment or
continued employment and to defend in any legal proceedings in which my employment
or actions are at issue.
DURATION:
‘This authorization shall become effective immediately and shall remain in effect
‘throughout the duration of my employment with the City of Pensacola and any post-
employment legal matters or proceedings, unless rescinded by me in writing.
RESTRICTIONS:
understand that the Drug Free Workplace Administrator may not further use or disclose
the medical information unless further authorization is given by me or in case of post
accident testing or disclosure is required or permitted by law or licensing authority.
ADDITIONAL COPY:
(1) further understand that I have a right to receive a copy of this authorization on my
request.
(2) I further agree that a reproduced copy of this form shall have the same force and
effect as the original.
DRUG SCREEN SPECIMEN VERIFICATION:
hereby authorize the hospital, clinic, or laboratory, its physicians and technicians,
specified by the City of Pensacola, to obtain a sample of my urine, blood, or breath to be
analyzed for the presence of controlled substances,
sionarne_Aarad I Jjiten oyre I~ 37-14 Policy on Prohibited Employment
Harassment and /or Discrimination
The City of Pensacola is committed to providing a work environment free from all
forms of discrimination and harassment based upon race, sex, color, religion,
national origin, age disability, marital status, veterans status or any other legally -
protected status. With regard to sexual harassment, no one — either male or
female ~ should be subjected to unsolicited and unwelcome sexual overtones,
comments, or conduct, either verbal or physical. Sexual harassment does not
refer to occasional compliments of a socially acceptable nature. Rather, it refers
to behavior which is not welcome, which is personally offensive, which debiltates
morale, and which interferes with work effectiveness ore personal comfort. Any
questions regarding this policy should be addressed to the Human Resources
Administrator.
You are expected to refrain from improper discriminatory or harassing conduct,
Likewise, any incidence of discrimination or harassment, sexual or otherwise,
should be promptly reported to your Department Director/Administrator. If you
are uncomfortable discussing the matter with your Department
Director/Administrator you may skip this step and make a report directly to the
Human Resources Administrator or designee. All claims will be investigated
promptly, thoroughly, and impartially, and appropriate corrective action will be
taken where it is determined that discrimination or harassment has occurred
Employees who make good faith complaints of discrimination or harassment will
be protected against retaliation. Confidentiality will be protected to the extent
possible.
Please sign below that you have received and agreed to abide by this,
important policy. Never hesitate to speak to Human Resources Staff about
questions or concerns. You are an important person in our organization.
I have reviewed the policy concerning discrimination and harassment and agree
to abide by the policy. | will immediately report any and all incidents of
discrimination or harassment as outlined in the policy, regardless of whether | am
the person being discriminated against or harassed or have witnessed such
conduct toward another employee.
Zhuad 3. dusvon auld
Employee Signature Daie
Educel F, Sisson
Print Your Name
a CITY OF PENSACOLA GENERAL OPERATING GUIDELINES
INJURY REPORTING
Thave read and understand to General operating guidelines for injury reporting for the City of
Pensacola
| Signature Ghured due ”
pae_2- f= 14
| Name (Print) duver fk. S1sm
Man kesources
Department: CITY OF PENSACOLA
NEW EMPLOYEE ORIENTATION
INVENTORY SHEET
|. Employee Information
a, Employee Handbook
b. Harassment / Discrimination Policy
©. Vehicle Use Policy
d. Injury Reporting Policy
e. Technology Resources Policy
f. City Council information
Il, Human Resource Information
a. Safety in the workplace
i. Worker's Compensation Memorandum
b. City Clinic
Ill, Employee Benefit Information
a, Leave
i. PTO
ii, Leave Sharing
ii, Anniversary Day
iv. Holidays
IV. New Employee Forms/Cards/Brochures
a, Wed
b. Employee Questionnaire
c. Outside Employment Form
d. United Way
e. Employee Identification Form
V.. Retirement Information
a. TROWE Price
b. Nationwide Retirement Solutions
c. Deferred Compensation Plan
|, Deferred Compensation Plan - Voluntary
d. Defined Benefit Plans
i. Florida Retirement System (FRS)
ii. Firemen's Relief and Pension Fund (uniformed fire only)
| hereby acknowledge that the above information was explained to me as part of the
New Employee Orientation and was included in my New Employee Orientation
Packet that has been provided to me upon my employment with the City of
Pensacola
Bad? Seam 9- I-44
Employee Signature Date
Revised 6/1/94 9/11/98, 10/18/00, 203, 715, 8107, 9109, 13,
f twalstvorientation\Orientation Inventory Sheet CITY OF PENSACOLA v
IDENTIFICATION CARD INFORMATION
(PLEASE PRINT)
EMPLOYEE NAME: Edurach f Ss 15901
SOCIAL SECURITY #:
EMPLOYMENT DATE: a 3
DEPARTMENT: Hannan Res ovcce >
PERSON TO NOTIFY IN CASE OF EMERGENCY
PRIMARY CONTACT:
NAME: El Alda cond 0
e 7
RELATIONSHIP: onc &
ADDRESS: NOC Buckhorn wer Urive
CITY, STATE, ZIP CODE: Vol Fico FL 535%
PHONE #: __ BID- bES- 0806 (Home)
sg gg ESE EESE ORR)
_ BIB- 475-9200 cy
OTHER CONTACT:
NAME: Loads vor Beet
RELATIONSHIP: Methe
ADDRESS: S600 Male uct
CITY, STATE, ZIP CODE: —Opelife Ae
PHONE #: HITE Salles Gk OUI ge
(WORK) a
DENIC AC if A
7
Technology Resources il
By signing below, agree tothe following terms:
(@__Thave received and read a copy of the City of Pensacola Technology Resources Acceptable Use Policy and
understand and egree tothe same;
(i) Tunderstand and agree that any software and hardware devices provided to me by the City remain the
property of the Citys
(iii) understand and agree [am not to modify, alter, or upgrade any software programs or hardware devices
provided to me by the City of Pensacots without the permission ofthe Technology Resources Division:
(iv) Tunderstand and agree that, if leave the City for any reason, I shall immediately return tothe City the
original and copies of any and allsoftware, computer materials, or computer equipment that I may have
received from the City that is either in my possession or otherwise dieetly or indirectly under my control,
() —Tunderstand and agree I must make reasonable efforts to protect all City provided software and hardware
devices from theft and physical damage.
Gadd J
ee fe 51900
Employee Printed Name
Human Resources
Tmployee Department Divi
Oley
Date
Page 4 of 5
April 2013 SCANNED
aH
CITY OF PENSACOLA
BACKGROUND AUTHORIZATION
As part of the application process, you were notified that the City conducts driver license and
background/criminal history checks for the position for which you applied. By signing and submitting the
electronic employment application, you consented to the release of information to authorized City employees.
By your completing and signing this form, you consent to continuing in the screening process and authorize a
review of your: driving record; background/criminal history; education history; and prior employment records.
The following information is required before proceeding; the form must be completed and returned to Human
Resources, located on the 4" floor of City Hall, 222 W Main Street, Pensacola, FL 32502, The form can be
returned in person, by regular mall or via fax to 850-595-1298.
Under Chapter 119, Florida Statutes, the application submitted for City employment and information obtained
during the screening may be public record unless exempted by law; if you are eligible for exemption, you must
notify Human Resources.
w
GAR Fastin WGC :
ee Sisson Edleoed| ae Freakin
iFyou have used any other name(s), please provid
Date off
iS Beng Sate Fy
Please call us at 850-435-1660 if you have questions or need assistance.
Ihereby authorize the City of Pensacola to collect the information as described above as part of the employment
screening process.
Applicant Signature: Aond 2 ’ Date. isi 2 {-/4
Thank you for your interest in employment with the City of Pensacola!
Gity of Pensacola - Human Resources
Attention: Assessment Services
222 W Main Street
Pensacola, Fl 32502 DRIVER RECORD SERVICE REPORT FOR FLORIDA aca
va com [REFORT DATE TEREQUESTOR | ACOT# [nSEGUENCER | BIN CODEIN PAGES
aaa euaataaiel o OT2772014 DEB 09 7E 582879181 000 1
cE ae TEP TUCENSEGASSE = TSTATOS
€ ‘VAUD
eeeTES — RESTRCHONS SD =
SUED EPRES EEE I TON wT z
oirraz008 | 0572672015 Gender M Height 59
aE IREPORT PRESARIO FORO
[cITY OF PENSACOLA, HUMAN RESOURCES aman Resources Administetor
50 BOX 12610
PENSACOLA, FL 92521-0001
‘This report is generated for employment purposes only and may not be used for any other purpose. The use and dissemination
(of the report and information in it must comply with your IIX agroomont and the Fair Credit Reporting Act, the Driver's Privacy
Protection Act, and any applicable state statute(s). The data In tho roport from the applicable state agency or service bureau is
provided through II "as is."
MISCELLANEOUS AND STATI IC INF¢
IPERS:O1: ACTIVE —VALID_E. 0118200803262015 M
Lic cass: € DESC: OPERATOR,
Lic STATUS: VALID
Lic ISSUED. 01/18/2008
Lic EXPIRES: 03/26/2015,
Lic RESTR: B DESO: OUTSIDE REARVIEW MIRROR
Lic eNDMT: M DESC: MOTORCYCLE
IAS OF JANUARY 27, 2014 AT 11:40:03 AM, DRIVER PRIVILEGE 1S VALID.
PERSONAL INFORMATION IS PROTECTED PURSUANT TO THE DRIVER PRIVACY PROTECTION ACT.
ENTRIES BELOW ARE A SEVEN YEAR RECORD.
[ORIGINAL ISSUE DATE: 12/28/2002
ISAFE DRIVER
lus cimizen
|BLOCKED PERSONAL INFORMATION
JBLOCKED FOR MAILING LIST
PERSON HAS A DIGITAL IMAGE
JELIGIBLE TO ELECT DRIVER SCHOOL. DRIVER HAS MADE 1 ELECTIONS. LAST ELECTION WAS ON 09/16/2005.
VIOLATIONS COMMITTED WHILE A COL HOLDER OR IN A CMV VEHICLE ARE NOT ELIGIBLE FOR DRIVING SCHOOL ELECTION.
ICOUNTY: HILLSBOROU
RESIDENTIAL ADDRESS}
ISSUANCE HISTORY:
LIC CLASS: CLASS E ISSUE DATE: 10/18/2005 ISSUE TYPE: DUPLICATE
LIC CLASS: CLASSE ISSUE DATE: 11/19/2007 ISSUE TYPE: DUPLICATE
LIC CLASS: CLASS E ISSUE DATE: 08/13/2008 ISSUE TYPE: REPLACEMENT
LIC CLASS: CLASS E ISSUE DATE: 12/22/2011 ISSUE TYPE: ADDRESS CHANGE
LIC CLASS: CLASS E ISSUE DATE: 07/052012 ISSUE TYPE ADDRESS CHANGE
LIC CLASS: CLASS E ISSUE DATE: 09/08/2013 ISSUE TYPE: ADDRESS CHANGE
EXAMS TAKEN’
VISION DATE TAKEN: 01/18/2008 COUNT: 1. STATUS: PASS
ROAD SIGN DATE TAKEN: 12/26/2002 COUNT: 1 STATUS: RECIPROCATED
ROAD RULES —_ DATE TAKEN: 12/262002_COUNT: 1. STATUS: RECIPROCATED
DRIVING DATE TAKEN: 12/26/2002 COUNT: 1 STATUS: REGIPROCATED
MOTORCYCLE RULES DATE TAKEN: 08/13/2008 COUNT: 1 STATUS: WAIVER
MOTORCYCLE SKILLS DATE TAKEN: 08/13/2008 COUNT: 1. STATUS: WAIVER
NOTE Request match analysis j dobeY
DRIVING RECORD HISTORY
TYPE VIOW/SUS__CONV/REI_DESCRIPTION CODE POINTS svc.
[viol 1728/2008 0171/2010 UNLAWFUL SPEED. 4
‘SPEEDING 70 IN A45 ZONE
DISPOSITION WAS GUILTY
VIOLATION NUMBER: 3
CITATION NUMBER: 2164
STATE: GA DRIVER RECORD SERVICE REPORT FOR FLORIDA ear
sy com ([REPORTOATE [REQUESTOR | ACCTAMESEQUENGE? | BILL CODE TRPACE:
Ueessiss oy Fran | oes tae Teapot 0
= SUICENSEE WANED aT TIGERSE CLASSE [STATUS
E ‘VALID.
ra RESTRIOHONS ST
B
1SSi "EXPIRES OD . (ER DESCRIPTION, peas
Dirter2008 | 031762015 ‘Gender MiHight 59
you are an ix Customer, and have Refer Consumer:
i ICECRA
11716 Brlarcrost Dr Ste 200 4746 Brlarcrest Dr Ste 200
Bryan, 1% 77802 Bryan, TX, TX 77802
[Teloptone: 1-800-683-9553
Telephone: 1-866-560-7015
‘== END OF REPORT *** Criminal SuperSearch Results
‘awe icon. [REBORRDATE”| REGUESTO [ACCT [PSEQUENCER"|—REPORUIOT
eee eer rere 01/27/2014 ‘DEB 4os792_| 582879182 1 H127201419015752
GREQUESTEDSUBECTNAME DST a ¥
EDWARD F. SISSON
T_T 1 REPORT BREPARED FOR ca COMMENT aE
CITY OF PENSACOLA, HUMAN RESOURCES. Human Resources Administrator
PO BOX 12810
PENSACOLA, FL. 32521-0001
‘This report has been generated for employment purposes only. and may be used solely as factor in evaluating the named individual for
‘empioyment, promotion, reassignmont or retention as an omployee and not for any other purpose. The use and dissomination of this
report and the information contained therein must be in accordance with your agreemont wth ilk and in compliance withthe Fair Crocit
Reporting Act and any applicable federal or state statutes. IX does not warrant or guarantee tho accuracy or completenoss of tho
infornation provided. A validated SSN only nicates that i has been verifed against information provided by the Social Security
‘Administration. It does not verify thet the SSN bolongs to the subject of the search. Proper use of tis report and final verification of the
‘named individuals identity is the usors sole responsbilty.
A search of our database yields no records for the subject.
Ifyou are an liX Customer, and have questions contact: Refer Consumer to:
ix InteliCorp Records inc. - An ISO Company
1716 Briarcrest Dr Sto 200 3000 Auburn Drive, Suite 410
Bryan, TX 7802 Beachwood, OH 44122
Telophone: 1-800-083-8553, Telephone: 1-216-450-5200
"END OF REPORT" PF-405 ‘Submit one copy
‘OUTSIDE EMPLOYMENT FORM
Name. Eolutted EE Sisson
Job Title, Haren Keseuctos Pb minis Department. Hanon Ke sources
oust tnpye Sahn Ngads Sly aoe fin Mh he 1 Sohal Hash PSC
_Ledpdedt Gov'bach
one npoyer 523 C4 snmadtesiperasor__Ledegendecd Con Frere
Duties. Delrveciog cetcyel, eduection Courses heough thee use a
beth chssrcim ond LOASE. instruction :
Hours (time of day) and days workea__ [hues —6 ‘00 8:30 Seat ¢ San bam, - 3'Wpm,
Average hours worked perweeh_ 20
Is there ANY way in which this employment might lessen your efficiency in performing your City job due
to lack of sleep, strenuous work, etc.?
Comments (by employee or supervisor}
i hereby swear all statements have been made fully and accurately. | will give immediate notification
upon termination of the above employment on "Termination of Outside Employment” form (PF-406).
Bund D dian 5- [5-14
Employee's Signature Date
Approved
Activit Not Approved
iy X_ Approved
Department Directot Not approved
Provide this copy to Human Resources for filing in the employee's personnel file. varuotd fe agisao dHL woyssrunu99 joyooTy ¥ Brig Gyunmusoy :
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