Flextime Request
| Name: ___________ | Title: ___________ | Date: ___________ | ||||||
| Exempt: yes no | Dept: ___________ | Mngr: ___________ | ||||||
NOTE: The person requesting flextime isresponsible for securing coverage if needed. | ||||||||
| Flexibility Requested: hours location Dates: ___________ | ||||||||
Explain (incl. datesand change from current schedule):
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| How will this enhance your ability to performyour job?
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| Team Involvement Needed: yes no Team Involved? yes no | ||||||||
| What coverage is needed?
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| What work will be done?
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| Who will benefit from work done?
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| Approved By:____________________________ Date: __________ | ||||||||
| – – – – – – – – – – – – – – – – – – – – – – – — – – – – – – – – – – – – – – – – – – – – – – – – – – – | ||||||||
COMPLETE AFTER FLEXTIME HAS BEEN UTILIZED | ||||||||
| How did flextime enhance your ability to getyour job done?
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| Did you accomplish the specific workdescribed in your request?
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How was it an improvement for any of thefollowing:
Explain:
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| Were you satisfied with the process? Why orwhy not?
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| Does this enhance your job satisfaction?Explain:
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| Did customers express satisfaction with workperformed?
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| Did this enhance your ability to perform yourjob? Explain:
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| Was the customer: internal external | ||||||||
TO BE COMPLETED BY SUPERVISOR | ||||||||
| Do you agree with the evaluation?yes no | ||||||||
| Could this use of flextime be improved?Explain:
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ATTACH ANY ADDITIONAL COMMENTS AND RETURNTO HUMAN RESOURCES | ||||||||
Reprinted withpermission from “ExhibitBook of Personnel Forms,” Watson Wyatt Data Services. For moreinformation, visit www.wwdssurveys.comor call 201/843-1177