"5 - 8 Hour Days Schedule Change Request Form"

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Schedule Change Request
5 – 8 Hour Days
Bridge Division
Employee Name:
Section/Location:
Date of Last Schedule Change:
Attach interoffice memo with justification for schedule change (see attached guidelines).
Anticipated Start Date:
(must be on a Sunday)
Employee Signature:
Date:
Completed by Employee’s Supervisor
Does the employees’ request meet the guidelines?
Yes
No
Employee’s Supervisor
Date
Assistant State Bridge Engineer
Date
APPROVED:
State Bridge Engineer
Date
Effective Date:
Rev. 07-2005
Original – Employee’s Personnel File
Schedule Change Request
5 – 8 Hour Days
Bridge Division
Employee Name:
Section/Location:
Date of Last Schedule Change:
Attach interoffice memo with justification for schedule change (see attached guidelines).
Anticipated Start Date:
(must be on a Sunday)
Employee Signature:
Date:
Completed by Employee’s Supervisor
Does the employees’ request meet the guidelines?
Yes
No
Employee’s Supervisor
Date
Assistant State Bridge Engineer
Date
APPROVED:
State Bridge Engineer
Date
Effective Date:
Rev. 07-2005
Original – Employee’s Personnel File
Guidelines for Schedule Change Request
Bridge Division
Justification will need to be provided to your immediate supervisor in writing explaining
how the work will be completed, coverage of daily and weekly office hours, and the
opportunity for interaction with employees and customers.
Immediate supervisors will approve or deny the request, based upon these guidelines. If
approved, the request will be forwarded to the appropriate Assistant Bridge Engineer and
then to the State Bridge Engineer.
After approval from the State Bridge Engineer, the request will be forwarded to the
Automation Liaison Analyst in administration for processing.
Employees must review Financial Management System Policy 16-01.13, Time and Leave
Reporting.
Rev. 07-2005
Original – Employee’s Personnel File
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