
(rev 04/2016)CalHR 183
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1. Employee Information
2. Alternate Work Week Schedule
Employee Name
Alternate Work Week Agreement
California Department of Human Resources
State of California
Today's DatePosition #
Division Effective Date
Please indicate which Alternate Work Week Schedule you are requesting (check one).
9/8/80 Work Schedule:
•
Regular Day Off (RDO):
(Monday - Friday)
•
Date of first RDO:
•
Regular Day Off (RDO):
(Monday - Friday)
4/10/40 Work Schedule:
Specify schedule and work hours:
Other:
If you are on a 9/8/80 Alternate Work Week Schedule, your work week for overtime purposes will start
mid-day on your regular day off (RDO). This change is being made for the purposes of computing your
40-hour work week and any overtime compensation due to you under the provisions of the Fair Labor
Standards Act (FLSA).
In signing this agreement, and in accordance with the provisions of the FLSA, you agree to permanently
maintain your agreed upon alternate work week schedule. Periodic changes will not be permitted unless
you are placed on jury duty, military leave, or non-industrial disability leave, at which time you must
return to a Monday-Friday, 8 hour day work schedule.
This agreement may be cancelled at any time by either you or the Department. Failure to comply with
the procedures as outlined in the CalHR Alternate Work Week Policy, including maintaining a minimum
of 40 hours of leave credits or other paid leave (other than sick leave), will cause you to be removed from
your alternate work schedule and return you to a normal Monday - Friday, 5/8/40 work week.
3. Approval
I have read and understand the above terms and conditions of the alternate work week schedule and
understand that this agreement is made in accordance with the provisions of the FLSA. I also
acknowledge receipt of CalHR's policy on Alternate Work Week Schedules and understand a copy of
this agreement will be placed in my official personnel file for audit purposes. I further understand that
any excess hours accrued as a result of this schedule will be compensated as straight time when paid
by lump sum, and any deficit hours will be charged to vacation, holiday credit, excess hours, personal
leave, annual leave, CTO or approved dock.
•
Work schedule for 8-hour day
(i.e. 8:00 a.m. - 5:00 p.m.):
•
Work schedule for 9-hour day
(i.e. 7:00 a.m. - 5:00 p.m.):
•
Work schedule for 10-hour day
(i.e. 6:00 a.m. - 5:00 p.m.):
Employee Signature Supervisor Signature
Division Chief Signature Personnel Officer Signature