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f �® PALS'BEACH COUNTY
CODE OF ETHICS
TRAINING ACKNOWLEDGEMENT
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Honesty-Integrity-Character
Legal Name: L L to 1 (Please print clearly)
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Employee Identification Number: //77
Agency/Municipality: De t/Board: Lrb mtgGt
By signing this acknowledgement, I am attesting that I have done the following:
to Read the Palm Beach County Code of Ethics Ordinance Ctrl+Click to follow linkl
AND
Have completed additional training by viewing one of the following:
[ ] The Code of Ethics Training Program on the Intranet/Internet. (Ctrl+Click to follow link)
The Code of Ethics Training Program on YouTube. (Ctrl+Click to follow link)
[ ] The Code of Ethics Training Program on DVD.
[ ] A live presentation given on —, 20—.
1 understand that I am responsible for understanding and abiding by the Palm Beach
County Code of Ethics as I conduct my assigned duties during my term of employment.
I also understand that the information in this policy is subject to change. Policy changes
will be communicated to me by my supervisor or through official notices.
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(Legali0 l4 _ ( (Date ,
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Advisory Board Members: Submitsigned forms to Appropriate Advisory Board Representative
PLEASE SUBMIT THIS FORM TO APROPRIATE PARTY AS HIGHLIGHTED ABOVE
PLEASE DO NOT SUBMIT THIS FORM TO THE COMMISSION ON ETHICS
300 North Dixie Highway,Suite 450,West Palm Beach,FL 33401
PHONE: 561.355-1915 FAX: 561.355-1904
Hotline: 877.766.5920 E-mail: ethicsCbpalmbeachcountyethics.cam
Website: www.palmbeachcountvethics.comi
Rev.01/2017
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PAIMBEACHCOUNTY
CODE OF ETHICS
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TRAINING ACKNOWLEDGEMENT
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Honest} -Integrity-Character
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Legal e:
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Employee Identification Number:
Agency/Municipality: . ° 4 Dept/Board:
By signing this acknowledgement, I am attesting that I have done the following:
[41 Read the Palm BeachEthics r i til+ tic li ►
AND
Have completed additional training by viewing of the following:
The Code of Ethics Training the Intranet/Internet. (Ctrl+click to followlink)
The Code of Ethics i in Program . (Ctrl+Click to follow link)
The Code f Ethics Trainingr .
jA live presentation iv
I understand that l am responsible fru rs in i i the Palm
County Code of Ethics as I conduct my assignedduties during term of employment.
I also understand that the information int i olicy is subject to change. Policy changes
will"be communicatedo me by my supervisor or throughofficial notices.
f
ww.._
(Legal Sign lure) (Date)' {
Advisory
Submitrv� signed forms to Appropriate Advisory Board Representative
PLEASE SUBMIT THIS FORM TO APROPRIATE PARTY AS HIGHLIGHTED
COMMISSIONPLEASE DO NOT SUBMIT THIS FORM TO THE I
300 North Dixie Highway,Suite 450,West Palm Beach,FL 33401.
561.355-1915 FAX: 561.355-1904
77.7 E-mail: ethics@)paimbeachcountyethics.co
sit : . a ac c e i s.
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