(page 1 of 2)

Application for Voluntary Reduction in Work Schedule (VRWS)

Agency Code:
Line No:_______________     NU:_______________
Percent Reduction in Work Schedule requested:
Number of pay periods of participation:__________pay periods
VR Time to be earned during agreement period:__________days
Beginning first day of pay period #________, (date) ________________, 20_______ Ending last day of pay period #_________, (date) ________________, 20________
Normal work schedule______________________ hours/week; ____________ hours/pay period. Reduced average work schedule______________ hours/week; ____________ hours/pay period.
VR Time earned___________________________ hours/week; ____________ hours/pay period.

Check type of Proposed Schedule of VR time use below. Specify schedule for use of VR time on page 2 of application.

A. Shorter workday/Normal workweek.
B. Shorter workweek/Normal workday.
C. Coordination with Alternative Work Schedule (AWS) arrangement: Longer workday/Shorter workweek.
D. Block(s) of time off.
E. Intermittent time off. (Specify pattern, if any.)________________________________
F. Combination of above.
Employee Signature:

  DISAPPROVED (attach written justification and transmit to Personnel Officer)

Effective Date: _____________________

I agree to the proposed temporary adjustment in work schedule and understand that this employee will work a prorated share of his or her normal schedule over the duration of the agreement period.

Supervisor - Date
Section Chief/Office Head - Date

  DISAPPROVED (Personnel Officer - Date)


AGENCY: KEEP VRWS APPLICATION FORM ON FILE                              (9/00)