Personalized Work Schedule Agreement Template
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1PERSONALIZED WORK SCHEDULE
AGREEMENT
Employee Name ________________________________________________
County Name __________________________________________________
County Number _________________________________________________
I agree that a flexible, personalized work schedule is a privilege which requires
written approval from my supervisor and PVA. I also agree that any abuse of this privilege
as determined by the PVA may result in revocation of the privilege and resumption of regular
work hours for a period to be determined by the PVA.
Option: ________________
A. Regular Work Hours (8:00 a.m. to 4:30 p.m.)
B. Five-Day Workweek with Flextime (7.50 hours between 7:00
a.m. and 7:00 p.m.)
Day
Hours
Monday
_______
________
Tuesday
_______
________
Wednesday
_______
________
Thursday
_______
________
Friday
_______
________
Saturday
________
________
Lunch
_______
________
I understand that this work schedule will continue until changed by the PVA or me. No
employee changes can be made except on a quarterly basis.
Agreed _____________________________
Date ________________________
Employee
Agreed _____________________________
Date ________________________
First Line Supervisor/ Timekeeper
Agreed _____________________________
Date ________________________
PVA
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Parent category: Business