Check the Flex Time Schedule You Would Like to Work

Instructions

Part I.

Employee, fill in the appropriate information on the first four lines. If you are submitting this application for the first time, check “New Policy.” If you are changing your flex time schedule, check “Changing Policy;” or if you are canceling your current flex time schedule and not signing up for a new one, check “Canceling Policy.” If you are a manager conducting the quarterly review, check “Quarterly Review.”

Part II.

Check the flex time schedule you would like to work.

·  Peak-Hour Flex Time – This flex time schedule shifts your daily work schedule either an hour and a half earlier or an hour and a half later while still working a normal day. Instead of the normal 8:30-5:00 day, you can work:

o  7 a.m. – 3:30 p.m.

o  7:30 a.m. – 4 p.m.

o  8 a.m. – 4:30 p.m.

o  9 a.m. – 5:30 p.m.

o  9:30 a.m. – 6 p.m.

o  10 a.m. – 6:30 p.m.

Your supervisor will need to coordinate your schedule with other flex time participants to ensure ample coverage from 8:30-5:00. Indicate the hours you would like to work.

After filling out Part II, you should sign and date the form, then give it to your supervisor, who will fill out Part III. After signing and dating the form, the supervisor should give you a copy, keep a copy and give the original to KarenRunyon.

To the Supervisor:

Part III.

If you accept the schedule for which this employee is applying, check “Approve.” If you do not and you check “Disapprove,” you are required to give an explanation in the space provided. If, after approving a flex schedule, you feel you need to discontinue an employee’s flex schedule, check “Discontinue.” You are required to give an explanation in the space provided. After signing and dating the form and securing the COO’s signature, give a copy to the employee, keep a copy and give the original to Karen Runyon.

Application for Requesting Flex Time

Instructions for filling out this application are on the back.

I. Name

Date Submitted:______Date Effective:

qNew Policy qQuarterly Review qChanging Policy qCanceling Policy

II. Type of Flex Time: (check one)

___Peak-Hour Flex Time . . . From _____to_____

Explain Schedule:

III. This section is to filled out by your supervisor.

Approve/Continue Disapprove/Discontinue

Date______Date______

If you are disapproving or discontinuing this employee’s flex time, please explain:

______

Employee’s Signature Date Supervisor’s Signature Date

______

COO’s Signature Date