Fillable Form-7058-Change-In-Work-Schedule-2015 NOTIFICATION OF TREATMENT BY PERSONAL PHYSICIAN

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Form-7058-Change-In-Work-Schedule-2015 NOTIFICATION OF TREATMENT BY PERSONAL PHYSICIAN

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CHANGE IN WORK SCHEDULE
Monthly Classified Employee
T
his form is to be completed when changing the work schedule of a monthly classified employee. This form is to
be used only when the change does not alter the employee’s salary. A change in work period, which increases or
decreases the months employed or in duty hours, which adds, changes or removes shift differential compensation
is to be submitted on a Personnel Requisition form 7002.
Name:
Location:
Date:
SS/ID #:
Classification:
Effective Date:
Work Schedule
Current Hours Worked
Hours Changed To
Total Daily
Work Hours
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
Non-Work Period
Current Months
Months Changed To
Date
Date
Date
D
istribution: DO Payroll Personnel File Campus Payroll Employee
Form 7058 Rev. 5/15
Diablo Valley College
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Form-7058-Change-In-Work-Schedule-2015 NOTIFICATION OF TREATMENT BY PERSONAL PHYSICIAN

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Completed 29 February 2020

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