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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 SUPERVISOR’S 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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