OUTSIDE EMPLOYMENT REQUEST

OUTSIDE EMPLOYMENT REQUEST
CARROLL COUNTY ETHICS COMMISSION

225 N. Center Street, Room 113 Westminster, Maryland 21157

(410) 386-2094
Application Date

MonthDayYear
Date
Employee Name
Phone Number
Department/Bureau
County Position Title
County Position Duties
Upload copy of Job Description

Cancelof
I hereby request approval for the following “outside” employment
Outside Employer Name and Address: (If self-employed, please provide home address)
Outside Position Title
Outside Position Duties:
Starting Date

MonthDayYear
Date
Length of Employment
SUPERVISOR’S SIGNATURE

Clear
DATE

MonthDayYear
Date
Choose One

ApprovedDisapproved
DIRECTORS’S SIGNATURE

Clear
DATE

MonthDayYear
Date
Choose One

ApprovedDisapproved
DEPARTMENT OF HUMAN RESOURCES

Clear
DATE

MonthDayYear
Date
Choose One

ApprovedDisapproved
ETHICS ADMINISTRATOR

Clear
DATE

MonthDayYear
Date
NOTE: If the outside employment circumstances change in any respect from what is approved, please
Should be Empty: