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FLEX-TIME REQUEST FORM

Date:
Name:
Title:
Department:
I am requesting the following working schedule:
Start Time

End Time

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Comment (optional):
FOR SUPERVISORS USE ONLY
Approved schedule:
Start Time

End Time

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Recommend alternative schedule:


Start Time

End Time

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Reason(s):
Request denied

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