Alternative Work Schedule Request Form printable pdf download

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