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MICHIGAN TECH FUND
FLEXTIME AND COMPRESSED WORK WEEK AGREEMENT
Part I – Flexible Work Option Selection
To be completed by employee
Employee name:
____________________________________________________________________________
Title: ______________________________________________________________________________________
Supervisor: _________________________________________________________________________________
This is a
New request
Renewal
Modification of current arrangement
Proposed flexible work options (FWO) start date: ____________________________
Proposed FWO end date: ______________________________
Type of FWO requested:
Flextime
Compressed work week
Flextime is an arrangement that allows a full-time exempt or non-exempt staff member to, with his or her
supervisor, agree on starting and ending times of the work day.
Fixed starting and ending times:
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Adjusted meal period:
Start Time
Length of Adjusted
Meal Period
End Time
Hours Worked
Compressed Work Week is an arrangement that enables a full-time employee to complete 40 hours of work in
fewer than five full days.
10-hour work day for 4 days with one day off per week.
Regular day off: _______________________
9-hour work day for 4 days with ½ day off per week.
Regular ½ day off: _____________________
Other – please describe: _________________________________________________________________
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Part II – Proposed Work Plan
To be completed by employee
Provide a written overview of the work arrangement you are proposing (attach additional sheets, if necessary). Be
sure to include the following information:
Proposed Work Plan (how you will provide the same or improved service to your internal and external
customers, co-workers, and Tech Fund/University departments):
Advantages to the Tech Fund:
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Plan for communication/cooperation with others in the office:
Plan for accessibility and responsiveness to work needs:
Plan for continuity of work:
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Plan for back-up, if needed:
Any obstacles you see that may result in the denial of your request, and your proposal to resolve and/or
address them:
By signing this agreement, I state that I have read and understand the Flexible Work Options guidelines and agree
to the terms and conditions set forth by this agreement. I believe that my work can be completed within the above
schedule with no loss of customer service or disruption to others in the Tech Fund the University. I understand
that it is my responsibility to make my flexible work arrangement a success. A supervisor or staff member may
terminate or modify the arrangement at any time within the guidelines of contractual obligations, if applicable. I
also understand that I must submit a new Flexible Work Options form anytime I wish to make a continuing
change to my schedule, including returning back to regular work hours.
_____________________________________________________
Employee’s signature
_______________________________
Date
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Part III – Supervisor Response
To be completed by the supervisor
Flexible work arrangement approved
Flexible work arrangement approved, with modifications
Describe modifications:
This arrangement will be reviewed at least annually by the supervisor and the employee.
Date for next review: ____________________________________
______________________________________________________
Supervisor’s signature
_______________________________
Date
NOTE: If you approve this FWO proposal for hourly staff, please review guidelines for hourly employees
regarding requirements for overtime pay.
Please submit completed forms to:
Human Resources Coordinator
Michigan Tech Fund
Please send notice of agreement to:
WorkLife Connections Office
Michigan Technological University
All Michigan Tech Fund flexible work options forms and guidelines have been adapted from the forms developed by
Michigan Technological University, with thanks to Cleveland State University, George Washington University, Cornell
University, Lehigh University, University of Pennsylvania, University of Kentucky, University of Arizona, and MIT whose
WorkLife websites were especially helpful and are quoted in these forms and guidelines.
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