METROPOLITAN STATE UNIVERSITY of DENVER
ALTERNATIVE WORK SCHEDULE REQUEST/AGREEMENT
I. Employee
Name: __________________________________ Date: _____________________________
Position/Title: ___________________________ Exempt Non-Exempt
Department: ____________________________________________________________________
II. Department Operating Hours: _______________________________________________
III. Workweek
IV. Suitability
How will the proposed schedule affect the ability of you and your work unit to get the job done? Please
address issues such as the extent your work depends on students or other staff, requires the presence of a
supervisor, how can productivity be measured, and describe the impact on co-workers and customer service.
V. Approvals
Alternative work scheduling is a management tool and the primary consideration is always the
department’s need. Approval of an alternative work schedule is at the sole discretion of the director. It is a
privilege, not a right or benefit, and an approved schedule may be discontinued or modified at any time.
Employee signature: _______________________________________ Date: ____________
Director signature: _______________________________________ Date: ____________
AVP signature: _______________________________________ Date: ____________
VP signature: _______________________________________ Date: ____________
Approved. Effective Date: _________End Date (if temporary): _____________________
Declined. Reason: _____________________________________________________________
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