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Okaloosa County BOCC — January 18, 2013 — Escambia County Ethics Policy — reading text
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employment of the County.
18. Prohibition against Misuse of Code. Individuals covered by this policy shall not use its
provisions to further false or frivolous claims against another. False claims shall be those
forwarded with knowledge that the claim contains one or more false allegations or with reckless
disregard for whether the complaint contains false allegations of material fact. The filing of a
false complaint shall be a violation of this policy.
19. Enforcement and Penalty. Pursuant to Subsection 112.317(3)(b), Florida Statutes, the Board of
County Commissioners finds that an efficient and effective method for the determination of
violations of the ethical standards set forth in this Policy is through local enforcement as
provided herein. This Policy may be enforced in any manner allowed, authorized, or otherwise
provided by law or ordinance, including Section 125.01, Florida Statutes.
a. For appointed public officers, who are members of County boards and committees, the
Board of County Commissioners may censure or remove that person for a policy violation
and prohibit him or her from being reappointed to a County board or committee for up to a
period of five (5) years or may refer the matter to the State Commission on Ethics for
investigation.
b. For County employees, such employees may be subject to employment sanctions for a
policy violation, including but not limited to, reduction in pay, reprimand, suspension, or
termination in accordance with the personnel procedures which are currently established
allowing for County classified or unclassified employees to be disciplined or the referral
of the matter to the State Commission on Ethics for investigation.
Page 61S (7 of 11)
20. Training, Administration and Records. The HR Director shall be responsible for training,
administration and records associated with the BCC Ethics Program. All County employees
classified as Senior Executive Service I or II are required to attend no less than two (2) hours of
ethics training on an annual basis. Ethics training shall additionally be made available to all
other supervisors and managers, and must attend a minimum of one (1) hour training annually.
The HR Manager shall be responsible for scheduling an adequate number of training sessions
and shall provide adequate notice of the training sessions. “Ethics Training” includes any
training on the provisions, application, and enforcement of this policy, on the provisions,
application, and enforcement of the State Code of Ethics, and any other ethics-based training for
public employees approved by the County Ethics Officer. Failure to attend the minimum
requirements for ethics training annually shall constitute a “for cause” basis for disciplinary
action.
ACKNOWLEDGEMENT OF RECEIPT
I have received and read the Escambia County Ethics Policy and agree to abide by its provisions and
uphold its policies.
Name: ______________________________ Job Title:__________________________
Department: _____________________________________________
Signature:___________________________ Date: ______________
Page 61S (8 of 11)
STATEMENT OF
FINANCIAL INTERESTS
LAST NAME --- FIRST NAME --- MIDDLE NAME: For Office
Use Only:
___________________________________________________ Date Received: ______________
MAILING ADDRESS: If change of address, check here:
By:________________________
________________________________________________________________
________________________________________________________________
CITY: ZIP: COUNTY:
________________________________________________________________
NAME OF AGENCY:
________________________________________________________________
NAME OF POSITION HELD:
________________________________________________________________
You are not limited to the space on the lines on this form. Attach additional
sheets, if necessary.
** BOTH PARTS OF THIS SECTION MUST BE COMPLETED**
DISCLOSURE PERIOD:
This statement reflects your financial interests for the preceding tax year, whether based on a calendar year or on a fiscal
year. Please state below whether this statement is for the preceding tax year ending either (check one):
December 31, 20_____ or Specify Tax Year if other than the calendar year: _______
PART A – PRIMARY SOURCES OF INCOME (Major sources of income over $2,500 min. to the reporting person, i.e.,
other employment, pensions, rental property)
Description of the Source’s
Name Source of Income Source’s Address Principal Business Activity
_____________________________ ______________________________ ______________________________
_____________________________ ______________________________ ______________________________
_____________________________ ______________________________ ______________________________
_____________________________ ______________________________ ______________________________
PART B – SECONDARY SOURCES OF INCOME (Major customers, clients and other sources of income to businesses
owned by the reporting person)
Name of Name of Major Sources Address Principal Business
Business Entity of Business’ Income of Source Activity of Source
______________________ ______________________ ______________________ ______________________
______________________ ______________________ ______________________ ______________________
______________________ ______________________ ______________________ ______________________
______________________ ______________________ ______________________ ______________________
HR2007-18 Submit Form to HR Dept.
Page 61S (9 of 11)
PART C – REAL PROPERTY – FLORIDA ONLY (Land, buildings owned by the reporting person)
PART D – INTERESTS IN SPECIFIED BUSINESSES (Ownership or positions in certain types of businesses, that have
currently or likely will do business with Escambia County BCC)
Business Entity # 1 Business Entity #2 Business Entity # 3
Name or
Business Entity
Address of
Business Entity
Principal Business
Activity
Position Held
With Entity
IF ANY OF PARTS A THROUGH D ARE CONTINUED ON A SEPARATE SHEET, PLEASE CHECK HERE
SIGNATURE (required): DATE SIGNED (required):
FILING INSTRUCTIONS
What to File: Where to File: When to File:
After completing all parts of this form, SES I and SES II non-reporting Within 30 days of the effective date of
including signing and dating it, submit employees submit this form to the HR the approved inclusion of the Escambia
only pages 1 and 2 to the HR Dept. of Dept. of the BCC. County Code of Ethics and every year
the BCC. thereafter by July 1.
If you have nothing to report in a
particular section, you must write
“none” or “n/a” in the section(s).
Facsimiles will not be accepted.
HR2007-18 Submit Form to HR Dept Page 2
Page 61S (10 of 11)
BOARD OF COUNTY COMMISSIONERS
CERTIFICATION OF OUTSIDE EMPLOYMENT
_______________________________ (name) do hereby state under oath that I engage in non-county employment.
This employment is conducted entirely in my off-duty hours, and I do not use or take advantage of any resources or
equipment of Escambia County in its performance. I understand and agree that such employment is secondary to my
County employment in all respects. Specifics regarding my outside employment follow:
1. Name and address of company/organization:
a) ___________________________________ b) _______________________________
___________________________________ ______________________________
___________________________________ ______________________________
2. Nature of Business or operations:
a) ___________________________________ b) ______________________________
___________________________________ ______________________________
___________________________________ ______________________________
3. Your Duties:
a) ___________________________________ b) _______________________________
___________________________________ _______________________________
4. To the best of your knowledge, do any of the companies/organizations listed above have a business relationship
with the Escambia County Board of County Commissioners?
Yes___ No____ If yes, please describe nature of business transactions: __________________________
_____________________________________________________________________________________
For purposes of this question, a “business relationship” may be ongoing, may have been conducted within the past 18
months, or may be intended to begin within the next 18 months.
I, by my signature below, certify that my outside employment does not now pose a conflict of interest with my current
County employment nor will such outside employment create such a conflict in the future. Should I discover that such
outside employment does indeed create such a conflict in the future, I will promptly advise my supervisor and the Ethics
Officer indicating that I will cease such outside employment or I will resign my current County position.
Also, I will promptly advise my supervisor and the Ethics Officer when there is a change or addition to my outside
employment listed above.
I understand and agree that for the purposes of this certification “conflict of interest” shall mean those conflicts set out in
Part III of Chapter 112, Florida Statutes and the Escambia County Code of Ethics Policy.
I understand and agree that violation of this certification in any aspect shall be grounds for disciplinary action by Escambia
County up to and including termination of my employment.
Name: _____________________________________________ Job Title: ________________________
Signature: __________________________________________ Date: ________________________
STATE OF FLORIDA
COUNTY OF ESCAMBIA
Subscribed and sworn to (or affirmed) before me this ________________________________________ by
________________________________
who is personally known to me or has produced ____________________________________________ as
identification.
