"Alternative Work Schedule Request Form"

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Alternative Work Schedule Request Form
An “Alternative Work Schedule” is an agreement between a staff member and the college
regarding a regular exception to “normal” work hours for the position. Allowing an
alternative work schedule is at the discretion of the college, and may be terminated by
either the staff member or the college, with or without cause, with reasonable notice.
Reasonable notice may require, on the part of either party, time necessary for a transition
back to “normal” work hours. This set of expectations is not a contract of employment
and may not be interpreted as such.
The duties, responsibilities, and conditions of employment remain unchanged. A staff
member working an alternative work schedule is expected to complete the
responsibilities of the position as if the staff member were working “normal” work hours
for the position.
Overtime compensation (for non-exempt staff) and vacation and sick leave will continue
to be based on time worked during the alternative work schedule. According to the
terms of this Agreement, the alternative work schedule is attached (attach a copy of
work schedule. For non-exempt staff, this specification must be in accordance with FLSA
guidelines and should include meal breaks). If the staff member needs to change this
schedule, he or she agrees to obtain advance written approval from the supervisor.
The alternative work schedule will begin on (specific start date) and is scheduled to end
on (specific end date) the following dates:
Begin Date________________
Scheduled End Date ____________________
I have read and understand the above expectations relating to the alternative work
schedule. I understand that my failure to adhere to the expectations may have an adverse
effect on my employment and may result in disciplinary action, including, but not limited
to the immediate withdrawal of the opportunity to benefit from an alternative work
schedule.
_____________________________
______________________________
Staff member’s signature
Supervisor’s signature
_____________________________
______________________________
Vice President’s signature
Human Resources signature
Alternative Work Schedule Request Form
An “Alternative Work Schedule” is an agreement between a staff member and the college
regarding a regular exception to “normal” work hours for the position. Allowing an
alternative work schedule is at the discretion of the college, and may be terminated by
either the staff member or the college, with or without cause, with reasonable notice.
Reasonable notice may require, on the part of either party, time necessary for a transition
back to “normal” work hours. This set of expectations is not a contract of employment
and may not be interpreted as such.
The duties, responsibilities, and conditions of employment remain unchanged. A staff
member working an alternative work schedule is expected to complete the
responsibilities of the position as if the staff member were working “normal” work hours
for the position.
Overtime compensation (for non-exempt staff) and vacation and sick leave will continue
to be based on time worked during the alternative work schedule. According to the
terms of this Agreement, the alternative work schedule is attached (attach a copy of
work schedule. For non-exempt staff, this specification must be in accordance with FLSA
guidelines and should include meal breaks). If the staff member needs to change this
schedule, he or she agrees to obtain advance written approval from the supervisor.
The alternative work schedule will begin on (specific start date) and is scheduled to end
on (specific end date) the following dates:
Begin Date________________
Scheduled End Date ____________________
I have read and understand the above expectations relating to the alternative work
schedule. I understand that my failure to adhere to the expectations may have an adverse
effect on my employment and may result in disciplinary action, including, but not limited
to the immediate withdrawal of the opportunity to benefit from an alternative work
schedule.
_____________________________
______________________________
Staff member’s signature
Supervisor’s signature
_____________________________
______________________________
Vice President’s signature
Human Resources signature