Reduced Hours Agreement Form
Submit your request and agreement for a change to reduced working hours.
Employee Full Name
*
First Name
Last Name
Manager/Supervisor Name
*
First Name
Last Name
Department or Position
*
Effective Period for Reduced Hours
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Proposed New Working Hours (e.g., Monday-Friday, 9am-1pm)
*
Reason for Requesting Reduced Hours
*
Employee Signature
*
Submit Agreement
Submit Agreement
Should be Empty: