Work Schedule Form

HRForm #101

San Francisco State University - Human Resources Department

WORK SCHEDULE

Please fill out the form and print it. After it has been signed, send the signed original to Human Resources.


		UIN


Effective Date:		Position Number(s)
Department:		AGY - UNIT - CLASS - SER
Classification:

Identify Position:(check all that apply)
	Full Time	Part-Time	Hourly
	Exempt	Non-Exempt	Intermittent
		4/10 or 9/80 Plan	Other ______________

This employee will work a schedule as indicated below. If a Permanent change to this schedule is made, a revised HR Form #101 is required before such change occurs.
This employee will work an irregular schedule varying according to workload requirements

(Please indicate below work schedule, Times & Days.)
Hours	Before Lunch		Lunch		After Lunch
Days	Begins	Ends	Begins	Ends	Begins	Ends
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Employee's Signature:	____________________________	UIN:	Date:
Type First and Last Name:			Extension
Supervisor's Signature:	____________________________		Date:
Type First and Last Name:			Extension
Dean/Director/ Administrator's Signature:	____________________________		Date:
Type First and Last name			Extension:

Please fill out the form and print it. After it has been signed, send the signed original to Human Resources.