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Item F13 B i BOARD OF COUNTY COMMISSIONERS AGENDA ITEM SUMMARY Meeting Date: 11/20/12 - KL Division Human Resources Bulk Item: Yes XX No _ Staff Contact Person: Teresa Apuiar 292-4458 AGENDA ITEM WORDING: Approval of employment agreement and confirmation of Isabel C. DeSantis as Executive Assistant to Commissioner Danny L. Kolhage, District 1. ITEM BACKGROUND: 2.03 B(7) of the Personnel Policies and Procedures requires approval of the BOCC. PREVIOUS RELEVANT BOCC ACTION: None. CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATIONS: Approval. TOTAL COST: $62,000 yr. +benefits INDIRECT COST: BUDGETED: Yes No DIFFERENTIAL OF LOCAL PREFERENCE: N/A COST TO COUNTY: $62,000 yr. +benefits SOURCE OF FUNDS: REVENUE PRODUCING: Yes No X AMOUNT PER MONTH Year APPROVED BY: County Atty X O*1B/Purc nIng Risk Management 44:', DOCUMENTATION: Included X Not Required DISPOSITION: AGENDA ITEM# MONROE COUNTY BOARD OF COUNTY COMMISSIONERS CONTRACT SUMMARY Contract with: Isabel C. DeSantis Contract# Effective Date: I t 17-0 f(2 Expiration Date: Contract Purpose/Description: Employment Agreement to serve as Executive Assistant to Commissioner Danny L. Kolha e, District 1 Contract Manager: Roman Gastesi County Administrator (Name) (Ext.) (Department/Stop#) for BOCC meeting on 11/20/12 Agenda Deadline: 11/6/12 CONTRACT COSTS Total Dollar Value of Contract: $ $62,000 yr Current Year Portion: $ +benefits Budgeted? Yes® No ❑ Account Codes: 001-00101-510-120- Grant: $ - - - - County Match: $ - - - - ADDITIONAL COSTS Estimated Ongoing Costs: $ /yr For: (Not included in dollar value above) (e .maintenance,utilities, janitorial,salaries,etc.) CONTRACT REVIEW Changes ........, . Date Out 74en NeededDivision Director �' Yes[E] No Risk Managdsind/— nt / �Yes[:] No[�°� O.M.B./Pur Yes❑N6® County Attorney i i 4 Yes❑ No y I A0 Comments: OMB Form Revised 2/27/01 MCP#2 EMPLOYMENT AGREEMENT BETWEEN MONROE COUNTY, FLORIDA AND ISABEL C. DESANTIS FOR POSITION OF EXECUTIVE ASSISTANT TO COMMISSIONER DANNY L. KOLHAGE THIS AGREEMENT is entered into upon the date last below written by and between Monroe County, Florida, acting through its Board of County Commissioners ("Board or "BOCC"), a political subdivision of the State of Florida, whose main business address is 1100 Simonton Street, Key West, Florida 33040, and Isabel C. DeSantis ("Employee"). WHEREAS,the position of Executive Assistant to County Commissioner Danny L. Kolhage, District I, is currently open; and WHEREAS,the BOCC has solicited applicants for the position; and WHEREAS, Employee has interviewed and been selected for the position; and WHEREAS, negotiations between the County and Employee have resulted in this mutually acceptable Employment Agreement ("Agreement"); NOW THEREFORE, in consideration of the mutual promises contained herein the County and Employee set forth herein, it is mutually agreed as follows: 1. EMPLOYMENT. Employee is hereby employed by the County as executive assistant to County Commissioner Danny L. Kolhage ("Commissioner"). Employee understands that he or she will initially be hired as an Emergency Temporary employee. Upon ratification by the Board of County Commissioners, the status of the Employee will then be converted to Contract Employee as that term is defined in Section 2.03 of the Personnel Policies & Procedures Manual ("Manual'), however, the date of hire will be treated as the date on which the Employee was hired as an Emergency Temporary employee, and the Employee will be eligible for any and all fringe benefits from the date of hire in accordance with the terms and conditions set forth in the Manual. 2. DUTIES. Duties of the Employee will be as set forth in the Job Description attached hereto as Exhibit A, the provisions of which are incorporated herein by reference. 3. COMPENSATION. In return for performance of the duties set forth in Exhibit A, including but not limited to specific duties assigned by the Commissioner from time to time, Employee shall receive an annual salary in the amount of$62,000.00. Except as otherwise set forth herein, the Employee shall also receive all benefits set forth in the Monroe County Personnel Policies & Procedures Manual ("Manual") as said Manual may be amended from time to time. County and Employee agree that the position of Executive Assistant will be a full-time position deemed non-exempt under the Fair Labor Standards Act. Work hours performed, annual leave, personal leave, and sick leave hours taken will be documented on a form or forms to be provided by County. - 1 - 4. SOLE EMPLOYMENT. The Employee agrees that he or she will not perform any work, consulting services, or other activities for any other person or entity, whether for remuneration or at no charge, without the prior express written approval of the Commissioner. 5. TERM OF AGREEMENT; TERMINATION; CANCELLATION; GENERAL RELEASE. The Employee understands that the appointment is a relationship that is highly dependent upon the personal and confidential relationship between the Employee and the Commissioner. In entering into this Agreement, the Employee therefore understands that he or she serves at the pleasure of the Commissioner; that there is no set term to this Agreement; and that the Employee can be terminated at any time upon twenty-four hours' written notice by the Commissioner, with or without cause, but that in any event the Agreement will terminate at the conclusion of the term of current office of the Commissioner. The Employee further understands that in the event of termination, the Employee is free to apply to the County for any other position then currently open and the County is free to consider the Employee for any open position, but that County has no obligation to place the Employee in another position, and specifically has no obligation to place the Employee in a position of equivalent or comparable salary, grade, or benefits. In entering into this Agreement, the Employee therefore specifically waives the right to utilize the grievance procedure set forth in Sections 9 and 10 of the Manual; House Bill No. 2658, Chapter 69-1321, the Monroe County Career Service Council; as well as any rights to which a Monroe County employee would otherwise be entitled under Chapter 447, Florida Statutes. As used in this paragraph, the term "for cause" will mean (a) dishonesty with respect to the business and operation of the County; (b) confirmed violation of the County's drug policy; (c)refusal to cooperate in an investigation regarding any aspect of the business or operation of the County, including but not limited to an investigation which is conducted by or at the express direction of the BOCC; (d) conviction of a crime which is classified as a felony or a crime involving moral turpitude; (e) gross neglect or willful and intentional misconduct; (f) conviction of a crime; (g) violation of a provision of the Monroe County Code; or(h) breach of any material term or condition of this Agreement by the Employee. 6. ATTORNEYS' FEES AND COSTS. In the event of any litigation initiated by either party, the prevailing party shall receive reasonable attorneys' fees, costs of litigation, and related expenses,both at the trial and appellate levels. 7. GOVERNING LAW; ATTORNEY'S FEES AND COSTS; VENUE. This Agreement is made in the State of Florida and will be governed by Florida law. This Agreement may be signed in more than one counterpart, in which case each counterpart will constitute an original of this Agreement. Paragraph headings are for convenience only and are not intended to expand or restrict the scope or substance of the provisions of this Agreement. Wherever used herein, the singular will include the plural, the plural will include the singular, and pronouns will be read as masculine, feminine, or neuter as the context requires. Monroe County, Florida will be the proper venue for any litigation involving this Agreement. This Agreement is not subject to arbitration. 8. OTHER TERMS AND CONDITIONS. A. Except as set forth herein, the Employee is subject to all terms and conditions set forth in the Monroe County Personnel Policies & Procedures Manual ("Manual") - 2 - as may be amended from time to time. To the extent there is a conflict between the terms of this Agreement and the Manual, the terms of this Agreement shall prevail. B. If any provision, term, or portion of this Agreement shall be held to be unconstitutional, illegal, invalid, or enforceable by a court of competent jurisdiction, the remaining terms, conditions, and portions shall remain in full force and effect as if originally agreed to without the term, condition, or portion that has been determined to be unconstitutional, illegal, invalid or unenforceable. C. The waiver by either the County or the Employee of a breach or violation of any term or provision of this Agreement by the other party shall not operate or be construed as a waiver of any subsequent breach or violation by the other party. D. The County and Employee acknowledge that each has shared equally in the review of this Agreement and, accordingly, no court or administrative hearing officer shall construe any provision of this Agreement more strictly against one party over the other party, and every term, condition, covenant, and provision of this Agreement shall be construed simply according to its fair meaning. Employee further acknowledges that she or he has had the Agreement reviewed by an attorney, or has been given the opportunity to do so and has waived that opportunity. E. This Agreement incorporates and supersedes all prior negotiations, correspondence, conversations, agreements, and/or understandings applicable to the matters contained herein. It is further agreed that there are no commitments, agreements, inducements, or understandings concerning the subject matter of this Agreement that are not contained herein, and no deviation from the terms hereof shall be predicated upon any prior representations, offers, promises, inducements, or agreements, whether oral or written, and by whomever made. F. The text herein constitutes the entire agreement between the Employee and the County, and this agreement cannot be amended except by a written document mutually agreed to and executed with the same formalities as this Agreement. The rights and obligations of this Agreement are personal to the Employee and cannot be assigned or transferred. - 3 - IN WITNESS WHEREOF, the parties hereto have set their hands and seals, in the County of Monroe, Florida, this, day of November, 2012. On behalf of Monroe County, Florida By: Roman Gastesi, County Administrator WITNESS: Employee By: r "Z By: [Print Name:] Isabel C. DeSantis MONROE COUNTY ATTORNEY I R=00L At T io M: CYNTHIA L. HALL ASSISTANT CCUNTY ATTORNEY Date 10-10-,2-O/: L -4 - Memo of Justification To: Teresa Aguiar, Division Director From: Danny L. Kolhage, Clerk of Courts DATE: October 18,2012 KE: Isabel DeSantis, District 1, Commissioner's Aide Mrs. DeSantis brings over(30)years of experience-as a whole—an Administrative Assistant with the Monroe County Sheriff's Department and as a Deputy Clerk in her current position with the Office of the Clerk of Courts to the position as an Executive Assistant to the County Commissioner for District 1. She has the experience, knowledge and familiarity with the processing of thousands of county documents related to actions taken by county commissioners via contracts,resolutions,and ordinances. She has taken official minutes for those meetings and is always willing to assist members of the public. In addition,Mrs. DeSantis is fluent in Spanish which is also an asset to my office to facilitate communication with many individuals from the public who will be entering my office on a daily basis looking for a Spanish speaking person to assist them in ascertaining information relative to all aspects of county government. For these reasons, I am asking for 2.6% above the top of the position pay scale range of$60,433.90 thereby bringing Mrs. DeSantis to a contracted salary of$62,000.00 per year. Thank you for your positive consideration on this request. Respectfully, 7 6b Kolhage Clerk of Courts and Commissioner Elect- District 1 MONROE COUNTY ADMINISTRATIVE SERVICES QUALIFICATION FORM (GRADE"9"Or Above) NAME OF APPLICANT: Isabel DeSantis POSITION APPLIED FOR: Executive Assistant -District 1 DEPARTMENT: BOCC AREA: Key West MEETS BASIC REQUIREMENTS ® DOES NOT MEET BASIC REQUIREMENTS ❑ CLAIMING VETERANS PREFERENCE ❑ IS NOT CLAIMING VETERANS PREFERENCE DATE OF REVIEW: 10/29/2012 ACCORDING TO THE JOB DESCRIPTION,THESE MEETS THE DOES NOT MEET DOES NOT MEET THE MINIMUM ARE THE MINIMUM QUALIFICATIONS: MINIMUM THE MINIMUM QUALIFICATIONS;HOWEVER DOES QUALIFICATIONS QUALIFICATIONS POSSESS COMPARABLE UALIFICATIONS AS LISTED H.S.Diploma or GED El ❑ 3to5 yrs.ex . ® ❑ ❑ ❑ ❑ El ❑ El ❑ ❑ ❑ ❑ ❑ ❑ ❑ COMMENTS: d gy HRREPRESENTATIVE .......` DATE / Monroe County Human Resources APPLICATION Date 10/t5I 10 MONROE COUNTY HUMAN RESOURCES FOR EMPLOYMElffle c�&6 Initials 1 100 Simonton Street 2 Floor Please complete ALL 5 pages of Application with ALL Attachments Key West,FL 33040 (305)292-4557 We consider applicants for all positions without regard to race, color, religion, creed, gender, national origin, age, disability, marital or veteran status, sexual orientation, or any other legally protected status. PLEASE PRINT Poshiion(s)Applied For: Date of.tpplication: ' D►•5-t • 1 L o- lam- 1 �- How did you learn about us? ❑ Newspaper Advertisement ElEmployment Agency ❑Friend Relative ❑Walk-In ❑Channel 76 ❑Internet Website Other Last Name First Na"�a Middle Name De S'an+iS- �Sa b-( Ce.0 i ( I q Address Number, Street City State Zip Code 1Q5 9.0 IV avCt Su.w\Me.4Ck ot_v\k k-,L 1i 3304ou Telephone Number(s) Last 4 Numbers of your octal Security Number (select): (select): s ck %Q) (select): Email Address(complete if you wish to be contacted by email) t c d 4L s a-�.-t- i S(,.L:N CA,\e q S , rt et If you are under 18 years of age, can you provide required proof of your eligibility to work? ❑Yes ❑No Have you ever filed an application with us before? ❑Yes ®No If Yes, give date(s) Have you ever been employed with us before? ❑Yes®No If Yes, give date(s) Are you currently employed? ]Yes❑No May we contact your present employer? ]Yes ❑No Are you prevented from lawfully becoming employed in this country because of Visa or Immigration Status? PtoofofcitL-ettchip or intntigrnttntn stuttts mttl be regttitrd upon eniplr�t•ruent ❑Yes [ONo On what date would you be available for work? 'De c- o—c ..) 2. O�'I- Are you available to work: [Full Time ❑Part'rime ❑Shift Work ❑Temporary Are you currently on "lay-off'status and subject to recall? ❑Yes r,71No Can you travel if a job requires it? ®Yes [:]No Have you been convicted of a felony within the last 7 years? Oyes X]No Conviction will not necesearilP disyttrtlili an upplkuut/runt rntt torment. If Yes, please explain Are you attaching a resume? It is not required. Dyes ®No If Yes, how many pages? _ WE ARE AN EQUAL OPPORTUNITY EMPLOYER Attachments:Slatement ol•Agreement I Dri%cr Allidarit 4 Applicant Retain: Application Into 7 Drugiice Wkpl 9 Veterans Prel''erence 2 Safety Sensni\e 5 Notice to Applicants 8 Benefits it a Glance 10 Urugl'ree Workplace 3 E170 Inlb Request 6 Monroe County Missinn.Vision,and Values 1 I Reminder to applicants 12 Human Resources Revised June,2012 Page I of 17 EDUCATION Name and Address of Course of Study Years Diploma School Completed— Degree Elementary School VY\Q.V% Pr High School Hi � Sc,� I ��.`� � r e� y �► �l omq COLA ( Sf,,S Undergraduate College Graduate Professional Other(Specify) Indicate any foreign languages you can speak, read and/or write FLUENT GOOD FAIR SPEAK READ WRITE Describe any specialized training, apprenticcship, skills and extra-curricular activities: Describe any 'ob-related training received in the United States military-, I luman Resources Revised June,2012 Page 2 of 17 EMPLOYMENT EXPERIENCE Start with your present or last Job. includ e any job-related d milita ry service assignments and volunteer activities. Yo u ou may exclude organizations which indicate race,color,reli ion,gender,national origin,disabilities or other protected status. 1. Employer �r Dates Employed Work Performed From To Address SOO l St'. 4. A S s t S 1 �N_ C'u K. Lu�� W1n\'��.ri e..c�,�, Telephone Numbers OLA\ A S�Q-C I S o� 30 Job Title Supervisor ( I lourly Rate/Salary11,i,-�t e S� t•e-• CA eat k—_ Y1 n KJhq o— Starting Final ��-��f Sl pal tJ,l C. C04%�-QC*l Reason for L aving /�000 � a� �c� Cap-��--e..r G�•a �. �1�000 (Icon Iv rn 5• 2. Employer Dates Emp yed Work Performed 5AI-r S From To Address Vct..ni0( CO(te)c Ck q �ivcsto,n Telephone Number(s) Job Title y Supervisor Ilourly Rate/Salary AS1V1. PCS.S \', Starting Final Reason for Leaving 3. Employer �� G Dates Employed Work Performed �e.CA< From To Address Cat Y� t O►V i�►�, 500 (}�I�;�-ehe�t�L�`t 1 a'a -a,. k co y Telephone Numbers) PrO�o_*e_l C.Ouw'\+ Job Title Supenisor Hourly Rate/Salary GV k r ( t)U,r i 1L)(JUa VeV Starting Final Reason for Leaving C_CIL-C $Q t✓ -a-Y\- 9 4. Employer Dates Employed Work Performed From To Address Telephone Number(s) Job Titic Super\isor I lourly RatePSalary Starting L inal Reason for Leaving If you need additional space, please continue on a separate sheet of paper. Ilurnan Resources Revised June,2012 Page 3 of 17 List professional,trade, business or civic activities and offices held. You may exclude membership whiclu would reveal gender,race,religion,national origin,age,uncesin,,disability or other protected status: IUD OV ADDITIONAL INFORMATION Other Qualifications Summarize special job-related skills and qualifications acquired from employment or other experience. �C_r_ ,r, k o3 t�) , ro ce SS i n a--,e w r"�t C_etCt Specialized Skills Check Skills/E ui ment Operated [Computer [calculator Production/Mobile Other(list): D oficrosoft Word gCopy Machine Machinery(list): ❑Access typewriter ❑Excel ]'Fax ..f�owerPoint PBX System ❑Other State any additional information you feel may be helpful to us in considering our application: Note to Applicants: DO NOT ANSWER THIS QUESTION UNLESS YOU HAVE BEEN INFORMED ABOUT THE REQUIREMENTS OF THE JOB FOR WHICH YOU ARE APPLYING: Are you capable of performing in a reasonable manner, with or without a reasonable accommodation, the activities involved in the job or occupation for which you have applied'? (A description of the activities involved in such a job or occupation is available.) NYES ONO References I. Name Address/Phune u _ 2 0. �L c. Name �tS -3 � 3 Address/Phone# 3. Name Address/Phone d Human Resources Revised June,2012 Page 4 of 17 STATEMENT OF AGREEMENT ATTACHMENT 1.1 I certify that answers given herein are true and complete to the best of my knowledge. 1 authorize investigation of all statements contained in this application for employment as may be necessary in arriving at an employment decision. I hereby understand and acknowledge that, unless otherwise defined by applicable law, any employment relationship with this organization is of an "at will" nature, which means that the Employee may resign at any time and the Employer may discharge Employee at any time with or without cause. It is further understood that this "at will" employment relationship may not be changed by any written document or by conduct unless such change is specifically acknowledged in writing by an authorized executive of this organization. In the event of employment, I understand that false or misleading information given in my application or interview(s) may result in discharge. I understand, also, that I am required to abide by all rules and regulations of the employer. Signature of Applicant Date Have you ever been "terminated"or"violated a Drugfree Workplace Policy" from a previous employer? OYES ONO. If YES, please explain Ifyoa have been "terminated"or "violated the DruKJree Prorkplace Policy"while employed with Monroe County BOCC,you cannot reapply for another County position.for six(6) months from your last date of employment. Have you ever been convicted of, plead guilty or Nolo to (regardless of whether adjudication was withheld) a violent crime or crimes, including Misdemeanors as well as Felonies? ❑YES ®NO If YES, please explain If you have not lived in Florida in the past(3)years it is necessary for you to obtain your past three years driving record from the previous state or states you have lived in. IDhave lived in Florida more than 3 years Dhave not lived in Florida more than 3 years I have read and understand the above: Jac. _ o Signature of Applicant Date Human Resources Revised June,2012 Page 5 ol'17 C UNTY jo '�MONROE BOARD OF COUNTY COMMISSIONERS KEY WESTLORIDA 33040 �° Mayor David Rice,District 4 (305)294-4641 Mayor Pro Tern IGm Wigington,District 1 George Neuge%District 2 Heather Carruthers, District 3 Sylvia Murphy,District 5 Employee Services Division Human Resources The Historic GATO Cigar Factory Facto "� 2 G t 1100 Simonton Street,2nd Floor Posting Date Key West,FL 33040 MONROE COUNTY PROMOTIONALOPPORTUNITYNOTICE THE POSITION OF EXECUTIVE ASSISTANT(COMMISSIONER AIDE).BOCC DISTRICT 1.KEY WEST IS NOW OPEN AT PAY GRADE 9 SALARY,$41.678.24-$60,433.90/40 HPW.(CONTRACT POSITION) (DEPENDING ON QUALIFICATIONS) • VETERANS PREFERENCE AVAILABLE: ®YES ❑NO • SAFETY SENSITIVE POSITION: ❑YES ®NO • GRANT POSITION(IF GRANT ENDS,POSITION WILL NOT BE CONTINUED) ❑YES ®NO THIS POSITION: ❑ IS A CAREER SERVICE STATUS POSITION ® IS NOT A CAREER SERVICE STATUS POSITION In accordance with the Monroe County Personnel Policies and Procedures, it is the policy of the Board of County Commissioners to consider employees for promotional opportunities before applicants from the general public are considered. Promotional Opportunity Notices will be posted for a minimum of seven (7)calendar days (including the date of posting) during which time employees under the auspices of the County Administrator will have the right to apply for these positions before anyone outside the County service will be considered. An employee wishing to apply for a position through the Promotional Opportunity process will complete the Promotional Opportunity Application and submit it to the Personnel Representative in the lower, middle,or upper keys for a date stamp to insure timely referral within the 7 day period. Supervisor and/or Department Head signature can then be obtained by the employee or routed by the Personnel Representative, whichever is more feasible. Job interviews will be based on information on file and/or submitted with an application. The County reserves the right to reject any applicat'o s submitted on a timely basis. EMPLOYEE §EWFC-9 DIVISION DIRECTOR MO.NROE COUNTY IS AN EQUAL OPPORTUNITY EMPLOYER CCCCO03 MONROE COUNTY JOB DESCRIPTION Position Title: EXECUTIVE ASSISTANT Date: 04/15/99 Position Level: 9 FLSA Status: Nonexempt— Class Code: 9-8 GENERAL DESCRIPTION Primary function is to perform highly specialized office and administrative work in supporting a Division Director or Commissioner. KEY RESPONSIBILITIES 1.*Act as personal secretary and or administrative aide. 2.*Prepare and/or research agenda items. 3. Assist in drafting and production of complex written correspondence and presentations. 4. Read,sort,and distribute all incoming and outgoing mail,as well as receive and screen callers. 5. Maintain supervisor's calendar and schedule,and make travel arrangements. 6. Help prepare annual budget and perform daily routine budgetary functions. 7. Take and transcribe dictation, i.e.,letters,memos,and independently prepare routine letters, etc. 8. Take and transcribe minutes of meetings. 9. Perform routine clerical functions(typing, filing,copying documents). * Indicates an"essential"job function. The information on this description has been designed to indicate the general nature and level of work performed by employees within this classification. It is not designed to contain or be interpreted as a comprehensive inventory of all duties,responsibilities and qualifications required of employees assigned to this 'ob. Position Title: EXECUTIVE ASSISTANT Class Code: 9-8 Position Level: 9 KEY JOB REQUIREMENTS Education: H.S. Diploma or GED required. Experience: 3 to 5 years. Impact of Actions: Makes decisions and final recommendations which routinely affect the activities of an entire department. Position duties may include responsibility for developing strategic tans for one or more divisions. Complexity: Analytic: Work is non-standardized and widely varied requiring the interpretation and application of a substantial variety of procedures, policies,and/or precedents used in combination. Frequently,the application of multiple,technical activities is employed; therefore,analytical ability and inductive thinking are required. Problem solving involves identification and analysis of diverse issues. Decision Making: Analytic: Supervision is present to establish and review broad objectives relative to basic position duties or departmental responsibilities. Independent judgment is required to study previously established,often partially relevant guidelines; plan for various interrelated activities;and coordinate such activities within a work unit or while completing a project. Communication Requires regular contacts to carry out programs and to explain specialized matters. Also with Others: requires continuing contacts with officials at higher levels on matters requiring cooperation,explanation and persuasion,as well as with the public involving the enforcement of regulations, policies and procedures. Managerial Skills: Has responsibility or authority which is limited to the direction of temporary workers. Working Conditions/ Work requires only minor physical exertion and/or physical strain. Work environment Physical Effort: involves only infrequent exposure to disagreeable elements. On Call None. Requirements: APPROVALS Department Head: Name: Signature: Date: Division Director: Name: Signature: Date: Countv Administrator: Name: Signature: Date: On this date 1 have received a copy of my job description relating to my employment with Monroe County. Name: Signature: Date: