Working Time Opt-Out Form
Formally declare your decision to opt out of the standard working time limit.
Employee Full Name
*
First Name
Last Name
Employee Email Address
*
example@example.com
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Department
*
Please Select
Human Resources
Finance
Operations
Sales
IT
Marketing
Other
Job Title
*
Manager/Supervisor Name
*
Employment Start Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Date Opt-Out Becomes Effective
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Opting Out (optional)
Signature
*
Submit Opt-Out Form
Submit Opt-Out Form
Should be Empty: