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Work Schedule Change Request Form

This document is a work schedule change/assignment form that contains fields for an employee's information like name and position details. It allows proposing a new work schedule with days and hours, including current and proposed schedules for up to two weeks. The form requires signatures from the employee and supervisor with an explanation for the schedule change.

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ivy
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14 views1 page

Work Schedule Change Request Form

This document is a work schedule change/assignment form that contains fields for an employee's information like name and position details. It allows proposing a new work schedule with days and hours, including current and proposed schedules for up to two weeks. The form requires signatures from the employee and supervisor with an explanation for the schedule change.

Uploaded by

ivy
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

WORK SCHEDULE CHANGE / ASSIGNMENT FORM

Last Name First Name Employee A Number FTE:


                       
Position Title Position is Overtime Eligible Position Number
      Yes No      
Date of Request / Notice Start Date of Change End Date of Change (if temporary)
                 
Human Resource Services must review and ensure compliance with work hour requirements
SCHEDULE Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Current
                                         
Week 1

Lunch Period                                          


Current
Week 2 (if
                                         
different from
Week 1)
Lunch Period                                          

SCHEDULE Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Proposed
                                         
Week 1

Lunch Period                                          


Proposed
Week 2 (if
                                         
different from
Week 1)
Lunch Period                                          

The Proposed work schedule is eligible for Shift Premium (Majority of time spent working between 5PM & 7AM)
Business need for Schedule Change:
     
Establish Schedule for New Employee Permanent Change
Check All That Supervisor’s Notice to Employee Temporary Change
Apply: Employee’s Request to Supervisor For Training Purposes
Mutually Agreed Change Emergency Schedule Change

Prior written notice of schedule change was given to employee on Month:       Day:       Year:      

Supervisor Signature Date      

Employee Signature Date      

Original: Human Resource Services Revised April 2014

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