"Employee Work Schedule Template"

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Employee Work Schedule Form
Effective Date:
Change:
Employee Name:
Personnel Number:
Select one of the three options provided:
Option 1: Five 8-hour days
Hours
0600 – 1430
0630 – 1500
0700 – 1530
0730 – 1600
0800 – 1630
0830 – 1700
0900 – 1730
Option 2: Four 10-hour days
Hours
Days
0600 – 1630
Monday ......
0630 – 1700
Tuesday ......
0700 – 1730
Wednesday .
OR
0730 – 1800
Thursday .....
0800 – 1830
Friday ..........
0830 – 1900
0900 – 1930
Option 3: Four 9-hour days + one 4-hour day
9-hour Day Options
4-hour Day Options
Hours
Days
Hours
Days
0600 – 1530
Monday .......
0600 – 1000
Monday ......
0630 – 1600
Tuesday .......
0630 – 1030
Tuesday ......
0700 – 1630
Wednesday ..
0700 – 1100
Wednesday .
0730 – 1700
Thursday ......
0730 – 1130
Thursday .....
0800 – 1730
Friday ...........
0800 – 1200
Friday ..........
0830 – 1800
0830 – 1230
0900 – 1830
0900 – 1300
1200 – 1600
1230 – 1630
1300 – 1700
1330 – 1730
Comments or Requests:
Employee Initial:
Employee Work Schedule Form
Effective Date:
Change:
Employee Name:
Personnel Number:
Select one of the three options provided:
Option 1: Five 8-hour days
Hours
0600 – 1430
0630 – 1500
0700 – 1530
0730 – 1600
0800 – 1630
0830 – 1700
0900 – 1730
Option 2: Four 10-hour days
Hours
Days
0600 – 1630
Monday ......
0630 – 1700
Tuesday ......
0700 – 1730
Wednesday .
OR
0730 – 1800
Thursday .....
0800 – 1830
Friday ..........
0830 – 1900
0900 – 1930
Option 3: Four 9-hour days + one 4-hour day
9-hour Day Options
4-hour Day Options
Hours
Days
Hours
Days
0600 – 1530
Monday .......
0600 – 1000
Monday ......
0630 – 1600
Tuesday .......
0630 – 1030
Tuesday ......
0700 – 1630
Wednesday ..
0700 – 1100
Wednesday .
0730 – 1700
Thursday ......
0730 – 1130
Thursday .....
0800 – 1730
Friday ...........
0800 – 1200
Friday ..........
0830 – 1800
0830 – 1230
0900 – 1830
0900 – 1300
1200 – 1600
1230 – 1630
1300 – 1700
1330 – 1730
Comments or Requests:
Employee Initial:
Flextime work schedules are probationary for a 90-day period, at the end of which the schedule will be
evaluated. All flextime schedules shall be evaluated annually by supervisors and division directors.
Flextime evaluations shall be based on such considerations as employee and workgroup productivity,
workload, absenteeism, punctuality, and overtime compensation.
A supervisor and/or division director may, at their discretion and at any time—including the 90-day
probationary period—implement, continue, discontinue, or modify an employee’s flextime schedule. A
supervisor and/or division director has the right at any time—including the 90-day probationary
period—to return an employee to a standard work schedule. Whenever possible, an employee will be
notified in advance of a flextime work schedule change.
Employee
Date
Supervisor
Date
Division Director
Date
Agency Director
Date
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