HomeMy WebLinkAbout106.011 - FC-02, Work Permit ApplicationEffective Date: September 2007 Ivy R. Estrada, Personnel Manager
Current Revision Date: 7/9/2024 Section 106.011
Next Revision (2) Date: 7/9/2027 Page 1 of 4
Fresno City Fire Department
100 Administrative Manual
SECTION 106.011 WORK PERMIT APPLICATION (FC-02)
PURPOSE
The FC-02 is the form to be completed by employees seeking approval to conduct
outside employment.
APPLICATION
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OPERATIONAL POLICY
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OPERATIONAL GUIDELINE
When an employee seeks permission for employment outside City service, an outside
work permit will be reviewed for approval for such periods of time as the City Manager
prescribes, but not to exceed a period of one year. If employment outside City service
continues for more than one year, a renewal application for the outside work permit
must be submitted.
PROCESS
A completed work permit application is sent to the Personnel Manager (or Fire Chief’s
designee) at Fire Headquarters for review. The Personnel Manager, with the Fire
Chief’s recommendation, will forward the work permit application to the Personnel
Services Department Director for City Manager approval.
An employee requesting a work permit for self-employment is not required to provide
a Workers’ Compensation policy number.
Note: At the Fire Chief’s discretion, review of an employee’s sick leave usage,
general attendance, on-the-job injuries, and subsequent restrictions will
be considered prior to recommendation, or revocation of the permit.
Effective Date: September 2007 Ivy R. Estrada, Personnel Manager
Current Revision Date: 7/9/2024 Section 106.011
Next Revision (2) Date: 7/9/2027 Page 2 of 4
INFORMATION
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DEFINITIONS
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CROSS-REFERENCES
Administrative Manual
Section 108.004, Work Permit Policy
Work Permit Application
Original: Personnel; Copy: Department; Copy: Employee
Page 3 of 4
Rev. 2/7/2020
Name:
Last First EEID #
Department: Work
Shift:
A - 8-10 Hours
Division: B - 24 Hours
Outside Employer:
Describe
Duties:
Address:
City: State: CA Zip:
Hours Worked Per Week
Hours Not to Exceed: 16 Hours (Work Shift A)
or 24 Hours (Work Shift B)
Employer’s Workers' Compensation Insurance Carrier /
Policy Number
The above statements are true and correct, and I understand the permission to engage in employment outside my regular City position
is revocable for good cause at any time by the City Manager or by my Department Head.
I have read and understand the restrictions printed on the reverse side of this form, and I agree to engage in only those off-
duty work activities compatible with my duties as a City employee. Further, I authorize the employer named above to release
to the City of Fresno information regarding my duties and time worked.
The rules governing off-duty work permits are contained in the Fresno Municipal Code Section 3-102 and Resolution No 93-323.
Review the Resolution prior to signing this application. A copy is available in the Personnel Department (Risk Management), 2600
Fresno Street.
Employee’s Signature Date
Approval Recommended Disapproval Recommended (explanation attached)
By recommending approval, it is my opinion that the work requested is not incompatible with
applicant’s City employment, nor will it impair his/her efficiency on the job.
Department Head Signature Date
Approval Recommended Disapproval Recommended (explanation attached)
Personnel Dept./Risk Management Authorized Signature Date
Approval Recommended Disapproval Recommended (explanation attached)
City Manager’s Designee Signature Date
PERMIT EXPIRATION DATE
(not to exceed (1) year from approval date)
Date
RESTRICTIONS ON WORK PERMIT
Original: Personnel; Copy: Department; Copy: Employee
Page 4 of 4
Rev. 2/7/2020
1.You are prohibited from engaging in any off-duty work, which would require approval,
inspection, or review by another City employee, in his or her official capacity, or work, which
is inconsistent, incompatible or in conflict with your City employment. (See Section 1126 of
the California Government Code and Fresno Municipal Code 3-102).
2.The Work Permit is not valid until approved in writing by the City Manager or their Designee.
3.You are prohibited from engaging in any off-duty work or activity for which you are
compensated or derive personal gain, whenever you are:
a.On sick leave, or
b.On injury leave (Exception: May be approved if consistent with medical
restrictions/limitations).
4.The number of hours worked per week shall not exceed the hours approved on the face of
this application.
5.Unless specifically authorized by your Department Head, the following is prohibited while
engaged in off-duty work for compensation or personal gain:
a.Wearing of a City uniform or any device or insignia, which identifies you as a City
employee.
b.Use of any City materials, tools or equipment.
6.Some types of outside work will require additional restrictions beyond those listed above.
Any special work restriction will be provided in writing at the time the work permit is issued.
Any outside work or activity in violation of the above listed restrictions, or any special
restrictions provided to you, may be cause for revocation of the work permit and
possible disciplinary action.