Work Schedule Shift Change Request - Wa
Work Schedule/Shift Change RequestSubmit completed form to your Human Resources (HR) Office. Form must be received by the HR Office prior to schedule effective date.Workweek: A fixed block of seven consecutive 24-hour periods.Work Schedule: Description of the days and hours within the workweek an employee is scheduled to work.Name (Last, First, Middle Initial)Enter text.Personnel NumberEnter text.Class TitleEnter text.Position NumberEnter text.New Position Number (If Changed)Enter text.Is Position Overtime Eligible?Yes ? No ?Effective Date (First day of Workweek)Enter a date.Work Location or UnitEnter text.Select Work Schedule from one of the drop down boxes below OR select Other.Select one. Select one. Select one. Select one. Other: Enter Work Schedule.Workweek 1SundayMondayTuesdayWednesdayThursdayFridaySaturdayDaily Shift Start TimeEnter text.Enter text.Enter text.Enter text.Enter text.Enter text.Enter text.Daily Shift End TimeEnter text.Enter text.Enter text.Enter text.Enter text.Enter text.Enter text.Length of Lunch BreakEnter text.Enter text.Enter text.Enter text.Enter text.Enter text.Enter text.Workweek 2 (If applicable)SundayMondayTuesdayWednesdayThursdayFridaySaturdayDaily Shift Start TimeEnter text.Enter text.Enter text.Enter text.Enter text.Enter text.Enter text.Daily Shift End TimeEnter text.Enter text.Enter text.Enter text.Enter text.Enter text.Enter text.Length of Lunch BreakEnter text.Enter text.Enter text.Enter text.Enter text.Enter text.Enter text.Reason for Work Schedule/Shift Change and Comments.Enter text.Check All That Apply: Supervisor’s Notice to Employee (Refer to WAC 357-28-252) ? For Training Purposes ?Employee’s Request To Supervisor ? Mutually Agreed Change ? Permanent Change ? Temporary Change ? DateEnter a date.Employee SignatureEnter text.DateEnter a date.Supervisor/Manager SignatureEnter text.For Human Resources Office Use Employee’s Work WeekEnter text.Copies Distributed ToHR Office (original) ? Attendance Keeper ? Employee ? Supervisor ?DateEnter a date.HR Designee’s SignatureEnter text. ................
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