Work Schedule Change Form - Executive Office Shared Environment

Preparer Information

Preparer Name(Required)

Your name

First Last

Preparer UW Email(Required)

Your UW email address

Alternate Contact

In the event of your absence, who should be contacted?

First Last

Alternate Contact UW Email

Alternate contact's UW email address

EO Assistance(Required)

Did you consult with or receive assistance from an Executive Office Shared Environment team member prior to filling out this form?

No

Yes

Team Member Name

First Last

Employee Information

Employee Name(Required)

First Last

Employee UW Email(Required)

Employee Unit(Required)

AP Sub-Units(Required)

ASA Sub-Units(Required)

DCCS Sub-Units(Required)

HSS Sub-Units(Required)

PRES Sub-Units(Required)

Work Schedule Changes

Effective Date(Required)

New work schedule effective date

Employee Change Request(Required)

Who is initiating this request?

Employee

Management

FTE Change(Required)

Does this work schedule change include an FTE change?

Yes

No

New FTE Percentage

New Work Schedule(Required)

Ex: M-F 8-2 PST

Correspondence Documentation Upload(Required)

Upload correspondence of schedule change request (employee initiated and manager approval).

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 15 MB.

Notification Documentation Upload(Required)

Upload formal notification of schedule change.

Drop files here or

Accepted file types: pdf, doc, docx, Max. file size: 15 MB.

Additional Information

Provide any additional, relevant information on needed action.