Request To Change Shift - St John'S Community Care

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An Activity of the Greek Orthodox Archdiocese of Australia
Request to Change Shift
Please note: For each Program and Client a new form must be completed. Form must be completed a
fortnight in advance except in the case of an emergency.
NAME: ...................................................................................... POSITION: ………………………………………..…
PROGRAM: .............................................................................. CLIENT: ……….……………………………………….
REASON FOR UNAVAILABILITY OF SHIFT:
……...…………………………………………………………………………………………………………………………………………….
…………………………………………….………………………………………………………………………………………………………
I hereby request to change my shift as indicated below:
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day/Date of Shift………… …. /….
Start… …
Finish … … Start … … Finish….
Day I return to my usual roster …………………… (Date) at ……………. am / pm
(Master)
...................................................................................
SIGNATURE
Employee
Approval ……………………………….
SIGNATURE
Coordinator/Team Leader
OFFICE USE ONLY
Date Received: …………………………..
Actioned in TRACCS: shift day/date....................... Shift day/date....................... Shift day/date.......................
Shift day/date………………….. Shift day/date………………….. Shift day/date………………….
Actioned By: …………………………………..
Date actioned: ………………………………….
ID#: F:E:10
Document title: Request to change shift
Access: All Staff
Version V2
Date last reviewed: 03/11/2015
G:\Forms\Employment\Rosters and Leave\Request to change shift

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