NEVADA DEPARTMENT OF CORRECTIONS
REQUEST FOR AN ALTERNATIVE SCHEDULE
NRS 284.180 (7) provides:
“Employees who are eligible under the Fair Labor Standards Act of 1938, 29 U.S.C. SECS. 201 et seq., to work a variable 80-hour work schedule within a biweekly pay period and who choose and are approved for such a work schedule will be considered eligible for overtime only after working eighty (80) hours biweekly except those eligible employees who are approved for overtime in excess of one scheduled shift of 8 or more hours per day.”
The employee completing this agreement does so voluntarily and with understanding of applicable state and federal law.
(Print Name)
for a variable work week schedule of 3 days on at twelve (12) hours per day, plus one (1) day on at eight (8) hours per day, 3 days off, 3 days on at twelve (12) hours per day and four days off. I understand that I will be working 44 hours one week and 36 hours the other week of each pay period, and that I will not be considered eligible for overtime until I work more than the scheduled shift per day or eighty (80) hours in a pay period or work one of my regularly scheduled days off.
This agreement will be in effect until rescinded in writing.
Agreed to on this ____________ day of _________________ in the year ____________
Employees Printed Name___________________________________________________
Social Security Number____________________________________________________
Employees Signature________________________________ Date_________________
Approved By: _____________________________________ __________________
Supervisor’s Signature Date
Approved By: _____________________________________ __________________
Appointing Authority’s Signature Date
DOC-1015 (rev. 7/01)