Staff Availability Survey
Employee Name
First Name
Last Name
Employee Position
Department
Primary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Secondary Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Email
example@example.com
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Person
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
What is preferred availability type?
Full Time
Part Time
Please select the days you're available to work
Rows
Yes
No
Time
Remarks
Monday
1
2
Tuesday
3
4
Wednesday
5
6
Thursday
7
8
Friday
9
10
Saturday
11
12
Sunday
13
14
In case we need someone to work during weekends and we need the staff to do a rotational off, are you willing to work during weekends?
Yes
No
If yes, how often do you want to work on weekends?
Once a month
Twice a month
Thrice a month
Other
What is your mode of transportation?
Train
Taxi
Bus
Car
Motorcycle
Other
Are you flexible at work in terms of scheduling?
Yes
No
Are you willing to be transferred to another location/branch?
Yes
No
If we have a stay-in or live-in program, are you going to avail it?
Yes
No
Are you okay if you are transferred from one department to another department?
Yes
No
Do you have any comments, suggestiosn or feedback?
Employee Signature
Date Signed
 -
Month
 -
Day
Year
Date
Submit
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