SUPERVISOR FLEXTIME FORM
As you are aware, your new contract requires that you work the hours your Department is
open unless you have a flex time schedule approved by the City.
A flex schedule must be a set weekly schedule, not one that has you coming in and
leaving a different hour each week. Your approved flex schedule will be your set
schedule until such time as you request another or the business needs of the City dictate
that your schedule needs to be changed to match the department’s operating hours, at
which time, we would notify you of the change with at least two (2) weeks notice.
Name: _________________________________________________________________
Dept: _________________________________________________________________
Dept. Normal Operating Hours: ____________________________________________
Date Submitted: ________________________________________
Please explain what provisions have been made for the department to operate during your
absence:
Employee’s Flex Schedule: M T W TH F
How long will this schedule be in place? ______________________________________
Dept. Head Signature: _____________________________________________________
Human Resources Director: _____________________________________________
Union Signature: _________________________________________________________
This form is to be completed and returned to the Personnel Department 2 weeks prior to
schedule change:
Schedules not approved will be returned within 10 days.
A copy of this form will be filed in your personnel file.
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