Ps Form 3189 - Request For Temporary Schedule Change For Personal Convenience
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1
2Request for Temporary Schedule Change
for Personal Convenience
For my own personal convenience, I ________________________________________
hereby submit this written request for a temporary change in my regular schedule from
(date) ____________________________ through _____________________________
From Regular Schedule:
Change Schedule To:
BT—
BT—
ET—
ET—
SDO—
SDO—
I understand that should this request be granted, I will not be entitled to the payment of
out of schedule premium for hours worked outside of and instead of my regular schedule.
Employee’s Signature
Social Security No.
Date Signed
Pay Location
I hereby condone and agree to the above request.
Steward’s Signature
Date Signed
Processing Date
PSD Tech Initials
APPROVED
DISAPPROVED (Give reason)
Supervisor’s Signature
Date Signed
3189
PS Form
, February 1986
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