HomeMy WebLinkAboutFC-02 - COF Work Permit Application
Work Permit Application
Name:
Last First EEID #
Department:
Division:
Work
Shift:
A -8-10 Hours
B -24 Hours
Outside Employer:
Describe
Duties:
Address:
City: State: CA Zip:
Hours Worked Per Week Employer’s Workers’ Compensation Insurance Carrier /
Hours Not to Exceed: 16 Hours (Work Shift A) Policy Number or 24 Hours (Work Shift B)
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 (FMC) Section 3-102. Review the FMC prior
to signing this application. The work permit application and applicable Resolution is available on the City of Fresno website under
the City Forms Management section of the employee share portal or in the Personnel Department (Risk Management), 2600 Fresno
Street, Room 1030, Fresno, CA 93721.
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 Date
(not to exceed (1) year from approval date)
Original: Personnel; Copy: Department; Copy: Employee
Page 1 of 2
Rev. 2/7/2020
RESTRICTIONS ON WORK PERMIT
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.
Restrictions on Work Permit Page 2 of 2
Rev. 2/7/2020