ALTERNATE/COMPRESSED SCHEDULED REQUEST
Name: Date:
Department: Title:
Proposed Schedule
Day of the Week
Date
Start Hour
Meal Period
End Hour
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
to
to
to
to
to
to
to
Total number of work hours per work week: _
ALTERNATE/COMPRESSED SCHEDULE AGREEMENT
I have read and acknowledge all provisions in
Policy 5.05 Flextime
&
Compressed
Work
Week Schedule
and agree to work the approved alternate work schedule from
, 20 to , 20 .
Employee Signature Date
Please Note:
The Fair Labor Standards Act (FLSA) requires that overtime compensation be paid
at one and one-half time the regular hourly rate for each hour worked over 40hours
during the non-exempt employee's designated workweek.
Averaging work hours over different workweeks is not permitted.
DEPARTMENT DIRECTOR ACTION
Request
Recommended:
From
,
20
T
o
,
20
Request Denied-Comments: _
Department Director Date
Appendix E
Form 13
Page 212 of 254
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