【正文】 to a different flextime schedule. Approval is the sole discretion of the Division Director or designee and, if approved, may be modified or discontinued at any time. The employee may also request to discontinue an approved flextime schedule at any time.Date: ______ Division Director’s (or designee’s) signature ________________Employee’s signature _________________________________Original to human resources office for personnel file. Copies to employee and supervisor.Revised: 11/1/01SAMPLE FORM BFLEXTIME REQUEST/AGREEMENTI. EmployeeName: __________________________________ Date:______________Class title: _______________________________ Exempt ____ NonExempt ____Division: _____________Work unit/section: ____________________II. WorkweekCurrent ScheduleStart/Stop TimesProposed ScheduleStart/Stop Times SundaySundayMondayMondayTuesdayTuesdayWednesdayWednesdayThursdayThursdayFridayFridaySaturdaySaturdayTotal work hoursTotal work hoursIII. SuitabilityHow will the proposed schedule affect the ability of you and your work unit to get the job done? Please note to what extent your work depends on customers or other staff, requires the presence of a supervisor, how productivity can be measured, the impact on coworkers, and the impact on customer service.IV. ApprovalsFlextime is a management tool and the primary consideration is always business need, and approval of an alternative work schedule is at the sole discretion of the appointing authority. It is a privilege, not a right or benefit, and an approved schedule may be discontinued or modified at any time.Employee signature: _________________________________Appointing authority signature: ______________________________ Date: _________Approved. Effective date: ____________ End date (if temporary): ____________Declined. Reason: ____________________________________________________Please file a copy of this document with the Human Resources OfficeSAMPLE FORM CA. FLEXTIME REQUEST/AGREEMENTDate: __________________________Name: _________________________Current Work Hours: _______________Requested Work Hours: _____________________Supervisor Approval: ______________________________________________________Basis for Request: Describe the basis for your request as it relates to the patibility of your job with an alternate schedule and the impact on the business needs of your work unit, such as your workload, responsiveness to customers, impact on coworkers, staff coverage in the unit.Supervisor: Submit pleted request form to manager if outside 7:00 to 6:00, Monday through Friday.SAMPLE FORM DB. FLEXTIME REQUEST/AGREEMENTName: ________________________ Date: ____________________Division: ___________________Exempt: ________ NonExempt: ________Current Work Hours: ______________Requested Work Hours: ____________Supervisor Approval: ______________________Basis for Request: describe how your job is suitable for flextime and the impact on the business needs of your work unit, such as your workload, responsiveness to customers, impact on coworkers, staff coverage, etc.____Request is approved and effective on: ______________________________Request is declined.Division Director (or delegated authority)_________________________Date: ___________Original to Office of Human Resources for personnel file.Copies to employee and supervisor by (insert date).