Appendix D
Indian Affairs
Maxiflex Work Schedule Agreement
Employee Name: ____________________________________________________________________________________
Position Title/Series/Grade: ______________________________________________________
_______ I would like to work full Maxiflex. My flexible arrival time band would be from _______ a.m. to _______
a.m., and my flexible departure time band would be from _______ p.m. to _______ p.m. I understand that I may not
arrive earlier than the beginning of the arrival band nor depart later than the end of the departure band. I may take a
flexible lunch with my supervisor’s approval between the hours of _______ a.m. and _______ p.m. Core hours are
9:30 a.m. to 3:30 p.m. on _____________________ (days of the week).
I understand that I must inform my immediate supervisor of my planned work schedule by the beginning of each pay
period.
_______ I would like to work Maxiflex 5/4-9 OR 4/10. My flexible arrival time band would be from _______ a.m. to
_______ a.m., and my flexible departure time band would be from _______ p.m. to _______ p.m. I understand that I
may not arrive earlier than the beginning of the arrival band nor depart later than the end of the departure band. I may
take a flexible lunch with my supervisor’s approval between the hours of _______ a.m. and _______ p.m. Core hours
are 9:30 a.m. to 3:30 p.m. on _____________________ (days of the week).
My schedule will be:
I have read, understand and agree to all the provisions of the Indian Affairs AWS policy that are applicable to the
work schedule I have requested.
I understand that Maxiflex is a privilege and as such I have no inherent right to a Maxiflex schedule and that the
approval of my Flexitime request is at the sole discretion of my supervisor.
I understand that I may not work more than 12 hours in a day unless required to do so as overtime. I further
understand that I may be requested to arrive at an alternative or a specific time on occasion when necessary to provide
office coverage, attend meetings, training, or conferences and that, when requested, I must comply.
Employee Signature: ________________________________________ Date: _______________
________ Approved _______ Not approved
Supervisor Signature: ________________________________ Date: ________________
Second Level Supervisor Concurrence: __________________ Date: ________________
(Only for “Not approved” and the reason must be articulated to the employee in writing.
You may attach the explanation to this agreement.)
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