You are on page 1of 1

Declaration of Availability

Name: Employee Number:

Department: Phone Number:

Period Covered: From: _____/_____/_____ To: _____/_____/_____


D M Y D M Y

DAY HOURS AVALIBLE

Sunday

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Please initial if you:


1. Do NOT wish to receive call-in shifts: __________
2. Wish to be scheduled more that 5 days in a week: __________

Signature Date

You might also like