Gordon, Golene �tossum oN I i 1 y Big IN U J BEACH
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• -‘:'l •I CODE OF ETHICS
9� TRAINING ACKNOWLEDGEMENT
�eFACH 0
Honesty-Integrity-Character
Legal Name: 6 /1,/ii L- aoY194-,w (Please print clearly)
Employee Identification Number: /,.,(e
Agency/Municipality: %A/i74V baGdi Dept/Board: ;`,
i ''-14/.1.) a/440/Y
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By signing this acknowledgement, I am attesting that I have done the following:
[t,}'Read the Palm Beach County 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 Intranetllnternet. (Ctrl+Click to follow link)
[(e 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 informatiomin this policy is subject to change. Policy changes
will be communicated to m by y supervisor or through official notices.
('' '-7
__....__ X /////e
(Legal Signature) (Date) I
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.palmbeachcountyethics.com
Rev.01/2017