Employee Work Schedule Change Form

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EMPLOYEE WORK SCHEDULE CHANGE FORM
ONE WEEK AT A TIME
This form is to be used for changing your work hours for a one week period for work related reasons only.
One form must be done for each week that a schedule change occurs.
Employee:
Reason for Change:
For this week only, I am changing my work hours to the following:
DATE
WORK DAY BEGINS
WORK DAY ENDS
# OF HOURS
Sun.
Mon.
Tues.
Wed.
Thurs.
Fri.
Sat.
TOTAL WEEKLY
37.5
HOURS
__________________________________________________
______________________________
Employee’s Signature
Date
__________________________________________________
______________________________
Supervisor’s Signature
Date
__________________________________________________
______________________________
Timekeeper’s Signature
Date

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