Form FDJJ1002.07-01 Attachment 1 "Secondary Employment Authorization Request (Outside of State Government)" - Florida

What Is Form FDJJ1002.07-01 Attachment 1?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on May 1, 2019;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form FDJJ1002.07-01 Attachment 1 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download Form FDJJ1002.07-01 Attachment 1 "Secondary Employment Authorization Request (Outside of State Government)" - Florida

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FDJJ 1002.07-1
Attachment 1
STATE OF FLORIDA
Revised 05/19
DEPARTMENT OF JUVENILE JUSTICE
SECONDARY EMPLOYMENT AUTHORIZATION REQUEST
(OUTSIDE OF STATE GOVERNMENT)
Employee’s PF ID#:
DATE:
Supervisor Name:
TO:
Employee’s Name:
Class Title:
FROM:
Please Print or Type
SUBJECT: DJJ
Employment Authorization Request
Secondary
Request for Fiscal Year: July 1, _______ through June 30, _________
Approval is valid ONLY for the fiscal year requested. To continue secondary employment from year to year, a new form
must be submitted prior to July 1 each year. The Supervisor may rescind approval. Secondary employment with a
contract provider (business entity) is prohibited if such employment violates the provisions of chapter 112, F.S. An
employee is subject to disciplinary action, up to and including dismissal, if he/she:
1. fails to seek approval for secondary employment prior to commencing the secondary employment;
2. fails to terminate secondary employment, when requested;
3. works the secondary employment while on an approved sick leave from the Department; or
4. works the secondary employment while receiving workers’ compensation benefits after authorization is suspended in
accordance with DJJ Policy 1002.
DJJ location at which you are employed:
(Name and Address) __________________________________________________________________
Program Area:____________________________ DJJ Tel. No.:______________________
DJJ Work Days/Hours: Days:
From:
AM/PM To:
AM/PM
Summarize your DJJ duties:
Name of Secondary Employer:
Address of Secondary Employer:
Name of Manager for Secondary Employer:
____ Tel. No.:
Title of Position:_________________________________________________________
Give specific details of your secondary employment work duties:
Give your secondary employment work days/hours: Days:
From:
AM/PM To:
AM/PM
Does the secondary employer do business with DJJ? (Check one)
Yes
No
If you check Yes, please explain:
Employee's Signature:
Date:
Supervisor Recommends:
Approved
Denied Signature:
Date:
Print Name:
Office of General Counsel:
No Conflict
Conflict
Potential Conflict. Refer to ELT Member for final determination
Signature:
Date:
Final Agency Action:
Approved
Denied Signature:
Date:
Selected Exempt or Senior Management Service Employee
A
/
:
Send copies to:
1. Human Resources Liaison
2. Bureau of Human Resources, 2737 Centerview Drive, Tallahassee, FL 32399-3100
FTER APPROVAL
DENIAL
Clear Form
Save As..
Print
FDJJ 1002.07-1
Attachment 1
STATE OF FLORIDA
Revised 05/19
DEPARTMENT OF JUVENILE JUSTICE
SECONDARY EMPLOYMENT AUTHORIZATION REQUEST
(OUTSIDE OF STATE GOVERNMENT)
Employee’s PF ID#:
DATE:
Supervisor Name:
TO:
Employee’s Name:
Class Title:
FROM:
Please Print or Type
SUBJECT: DJJ
Employment Authorization Request
Secondary
Request for Fiscal Year: July 1, _______ through June 30, _________
Approval is valid ONLY for the fiscal year requested. To continue secondary employment from year to year, a new form
must be submitted prior to July 1 each year. The Supervisor may rescind approval. Secondary employment with a
contract provider (business entity) is prohibited if such employment violates the provisions of chapter 112, F.S. An
employee is subject to disciplinary action, up to and including dismissal, if he/she:
1. fails to seek approval for secondary employment prior to commencing the secondary employment;
2. fails to terminate secondary employment, when requested;
3. works the secondary employment while on an approved sick leave from the Department; or
4. works the secondary employment while receiving workers’ compensation benefits after authorization is suspended in
accordance with DJJ Policy 1002.
DJJ location at which you are employed:
(Name and Address) __________________________________________________________________
Program Area:____________________________ DJJ Tel. No.:______________________
DJJ Work Days/Hours: Days:
From:
AM/PM To:
AM/PM
Summarize your DJJ duties:
Name of Secondary Employer:
Address of Secondary Employer:
Name of Manager for Secondary Employer:
____ Tel. No.:
Title of Position:_________________________________________________________
Give specific details of your secondary employment work duties:
Give your secondary employment work days/hours: Days:
From:
AM/PM To:
AM/PM
Does the secondary employer do business with DJJ? (Check one)
Yes
No
If you check Yes, please explain:
Employee's Signature:
Date:
Supervisor Recommends:
Approved
Denied Signature:
Date:
Print Name:
Office of General Counsel:
No Conflict
Conflict
Potential Conflict. Refer to ELT Member for final determination
Signature:
Date:
Final Agency Action:
Approved
Denied Signature:
Date:
Selected Exempt or Senior Management Service Employee
A
/
:
Send copies to:
1. Human Resources Liaison
2. Bureau of Human Resources, 2737 Centerview Drive, Tallahassee, FL 32399-3100
FTER APPROVAL
DENIAL
Clear Form
Save As..
Print