Appendix 5

Social Sciences & Humanities Library

Request Form for an Alternative Work Schedule

Date:

Name:

Job Title/Classification:

Department/Unit:

Quarter Requested:

I request permission to begin the following alternative work schedule:

- [Enter various scheduling options here]

-

-

-

-

- Other – Please explain

If approved, I understand that this would be a temporary modification to my existing schedule and for the duration of the quarter only. I also understand that the goals of the library may preclude granting my request and that even if my request is approved may be rescinded based on the scheduling needs of the library.

Signatures and dates:

Supervisor:

Department Head: