Pollack, Robert CII }. CI rh l UH BEACH
C rl Y CL ER i'S OFFICE
,�sr<moke.
`off. !� . PALL!BEACI ``COUNT 'i 10: 5g
CODE OF ETHICS
i TRAININGACKNOWLEDGEMENT
Hone*,-Integrity-Character
Legal Name: . Are-be L 'I :(7` I i '� (Please print clearly)
Employee Identification Number: - ._
Pede
rityi
Oh
Agency/Municipality: I epnboard: d:;, -
By signing this acknowledgement, I am attesting that I have do -= he following:
[ ] Read the.Palm-Beach_CountyCode_of.-Ethics_.OrdinanceE'(Ctr-I+Click-to-follow link1.,
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_Y_ouTube.;(Ctrl+Click to follow link)
[ ] The Code of Ethics Training Program on DVD.
[ ] A live presentation given on . ,20_.
I 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 by,my supervisor or through official notices.
.r
'7
`(Legal Signature) (Date)
Wfin?)
Advisory Board Members: Submit signed 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: ethics@palmbeachcountyethics.com
Website:.www.palmheachcountyethics.com
Rev.01/2017