Dornblaser, Timothy -- 0 �� , 47,g % PALM BEACH COUNTY
, ,►* s l CODE OF ETHICS
TRAINING ACKNOWLEDGEMENT
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Honesty-Integrity-Character
Legal Name: 1 vel.` .../. Mo `JoN AL to SF c (Please print clearly)
Employee Identification Number:
Agency/Municipality: Ll At.L c C‘ Dept/Board: tiot6, ,ra, onnI
By signing this acknowledgement, I am attesting that I have done the following:
Yx Read the Palm Beach County Code of Ethics Ordinance (Ctrl+Click to follow link) t
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Have completed additional training by viewing one of the following: wrn
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[ •.]_The Code of Ethics Training Program on-the Intranet/Internet. (Ctrl+Click to folio nk)o c
.4 The Code of Ethics Training Program on YouTube. (Ctrl+Click to follow link) _ "rn
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[ ] 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 thiss-policy is subject to change. Policy changes
will be communicate. . - : my supervisor or through official notices.
ANL _ - ,U 5 15
(Legal Signature (Date)
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Advisory Board Members: Submit signed forms to Appropriate Advisory Board Representative
PLEASE SUBMIT THIS FORM TO APROPRIATE PARTY AS HIGHLIGHTED ABOVE
PLEASE DONOT 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.palmbeachcountyethics.com
Rev.01/2017