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Appendix 1 - Staggered Hours Form

This form is used to request, review, and modify staggered work hour arrangements. It collects an employee's name, designation, staff number, department, supervisor's name, proposed start date, and preferred staggered work hours band. The employee must also provide their reason for choosing staggered hours and sign to acknowledge their understanding that the arrangement does not amend their employment contract and is subject to their supervisor's and department's discretion based on business needs. The supervisor then indicates if the request is approved or rejected, provides an effective date if approved, and signs along with the head of department and employee.

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25 views2 pages

Appendix 1 - Staggered Hours Form

This form is used to request, review, and modify staggered work hour arrangements. It collects an employee's name, designation, staff number, department, supervisor's name, proposed start date, and preferred staggered work hours band. The employee must also provide their reason for choosing staggered hours and sign to acknowledge their understanding that the arrangement does not amend their employment contract and is subject to their supervisor's and department's discretion based on business needs. The supervisor then indicates if the request is approved or rejected, provides an effective date if approved, and signs along with the head of department and employee.

Uploaded by

pbc3199
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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APPENDIX 1 STAGGERED WORKING HOURS FORM

This form is used for the purpose of requesting, reviewing and modifying staggered hours
arrangement
To be filled by the employee:
Name : ________________________________________________
Designation : ________________________________________________
Staff No : ________________________________________________
Department : ________________________________________________
Supervisors Name : ________________________________________________
Proposed Start Date : ________________________________________________

Please indicate your preferred staggered hours band below. The selected option will be
established as your daily working schedule under this work arrangement.

Preferred Staggered Hours


Staggered Hours Band Band
(Tick only ONE Option)
8:30 am - 5:30 pm
8:00 am - 5:00 pm
9:00 am - 6:00 pm
Please answer the following question :
What is/are the reason(s) for you choosing the staggered hours arrangement?

To be filled by the Supervisor


Approved/Rejected Effective Date
If rejected, state reason :

I understand that the approval of staggered hours arrangement does not amend
my employment contract
I understand that the staggered hours arrangement is subjected to the discretion
of my supervisor and
Department and may be suspended and terminated depending on business
needs.

Employee Signature Date :

Supervisor Signature Date :


Head of Department Date :

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