Opm Administrative And Residual Alternative Work Schedule Request Form
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1OPM ADMINISTRATIVE AND RESIDUAL ALTERNATIVE WORK SCHEDULE REQUEST FORM
Place a check mark in the box for the Alternative Work Schedule you are requesting. If you are requesting, “weekly
Instructions:
variable starting/quitting time” or “any other variation” or 5/4 4/5 Biweekly Fixed Schedule, please delineate intended
schedule on below grid and forward to your supervisor for approval.
Employee Name:
Division:
Unit:
Request participation in the:
Unrestricted daily starting/quitting time; around a core hour structure. (Pure Flextime)
Weekly variable starting/quitting time; around a core hour structure.
Any other variation around a core hour structure.
5/4 4/5 Bi-Weekly Fixed Schedule.
Start Date:
End Date:
Friday
Monday
Tuesday
Wednesday
Thursday
Friday
Monday
Tuesday
Wednesday
Thursday
Arrival Time
Lunch
Out
Lunch
Return
Departure
Time
Total
Hours
Employee Signature: _______________________________ Date:
Supervisor Recommendation (Check one)
Division Head Recommendation (Check one)
Approved
Disapproved
Approved
Disapproved
Supervisor Signature: ______________________________
Division Head Signature: ______________________________
Date: __________________________
Date: ________________________
Comments:
Comments:
cc: OPM Personnel Manager
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Parent category: Business