Name: Pediatric People
Price range: $

Purpose
This form is to be used whenever an employee is requesting to change shifts with another employee.

Procedure
1. Please submit requests as far in advance as possible/practical in the situation.
2. Both employees must agree and sign the form before it can be submitted and approved by your supervisor.
3. Submittal of this form does not guarantee the schedule change is approved; it must be approved by your manager to be considered approved.
4. Once agreed upon and approved by your supervisor, both parties are responsible in covering requested shift(s).
Employee 1 Information
Employee 1 will complete both sections: Employee 1 Information (the person requesting to change) and Employee 2 Information (the person agreeing to change).
Employee 1 Name*
First Last
Employee 1 Email*
Employee 1 Current Shift Date:*
MM slash DD slash YYYY
Employee 1 Current Shift Time Start:*

: Hours

Minutes

AM/PM
Employee 1 Current Shift Time End:*

: Hours

Minutes

AM/PM
Employee 1 Requested Shift Date:*
MM slash DD slash YYYY
Employee 1 Requested Shift Time Start:*

: Hours

Minutes

AM/PM
Employee 1 Requested Shift Time End:*

: Hours

Minutes

AM/PM
Notes:
Manager's Name*
- Rebecca Goslin
Employee 1 Signature*
Today's Date*
MM slash DD slash YYYY
Employee 2 Information
Employee 1 will complete both sections: Employee 1 Information (the person requesting to change) and Employee 2 Information (the person agreeing to change).
Employee 2 Name*
First Last
Employee 2 Email*
Click on "Send To Employee 2" (bottom of page) to send to Employee 2 to complete the next section.
Employee 2 Approval
(To be completed by Employee 2)
I approve the shift change.*
- Yes
- No
Employee 2 Signature*
Today's Date*
MM slash DD slash YYYY
Name
This field is for validation purposes and should be left unchanged.

Send To Employee 2

Shift Change Request

Employee 1 Information

Employee 2 Information

Employee 2 Approval