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Outside/Concurrent Employment

  1. Broward County Code of Ethics Disclosure Form

  2. Outside/Concurrent Employment

  3. Name of Outside or Concurrent Employer/Employment

    Please include both the name of the employer and position held.

  4. Remuneration or Payment Amounts Received in Prior Year

  5. Acknowledgement of Receipt

  6. Leave This Blank:

  7. This field is not part of the form submission.