North, Dr. Tiffany o PALM BEACHCOI11 ' '
• CODE OF ETHICS
TRAINING ACKNOWLEDGEMENT
TACH
Honesty-Integrity-Character
Legal Name: 1 _ _ (Please print clearly)
Employee Identification Number:
Agency/Municipalityip Oept/Board: L U
By signing this acknowledgement, I am attesting that I have done the following:
[(Read the Palm Beach Count Code of Ethics Ordinance Ctrl+Click to follow link
AND
Have completed additional training by viewing one of the following:
[ ] The Code of Ethics Training Program on the IntranetlInternet. (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_
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 comm ted to me y supervisor or through official notices.
:
(Legalg. a (Date)
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: ethicsCibpalmheachcountyethics.com
Website: vw. aimbeachcount ethics.com
Rev.01/2017
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CODE OF ETHICS'
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Honesty-Integrity-Charade,'
Legal Name: 7-171:-a1\L? ‘1)0P--4.- . (Please orintolearly)
Employee Identification Num er: las\ 4- N6Ft-s - 4 2_2g(.0. -
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Agency/Municipality: Dept/Board:: Cl..k..-
By signing this acknowledgement, I.am attesting that I have,done the following:
Head The.Palm Beach CoUntV Code of Ethics Ordinance (Ctrl+Click tO:follo1.4 link)
AND
Have completed additional training by viewing one of thefollOvying:
[ ] The Code OfEthics,Training f'rOgrara on the Intranet/interilet.:(ctrklick to falls:W.1110)
/
M The Code of Ethics Training Program on YouTube. (Ctrl+Click to follow 110)
[ .] The Code'of Ethics Training Program on DVD.
[ ] A live preaentation 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.-alw understand that the infori.ation in this policy is subject to change; Policy changes
willbe corn';'o rn ated to me . y'supervisor or through official notices.
/ 9--•-2/ .1.9
, ,i gall tare) (Date)
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Advisory Board 'embers: BOrnitaigped 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
lietli4e; 877.766.5920 E-mail: ethics@palmbeachcountyethics.com
Website: Www.pahnbeadicountvethics.com
Rev.01/20.7