AVAILABILITY FORM
This form will help us in determining your work availability and goals. Please completed the questions below, answering the questions as honestly as possible. This form will go into a file and be used in reference in scheduling you.
Rank in order of preferences and availability the shifts you would work, 1 being the most preferred and 3 being the least:
Graveyard (3rd Shift)
Swing (2nd Shift)
Days (1st Shift)
Please list the days and times you are available each day: Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
No Preference
[ ] All Day
[ ] All Day
[ ] All Day
[ ] All Day
[ ] All Day
[ ] All Day
[ ] All Day
Are you willing to work overtime? [ ] Yes [ ] No
Would you want to be on our “on-call” list for emergency fill-in jobs? [ ] Yes [ ] No Are you willing to work nights? [ ] Yes [ ] No
Are you willing to work holidays? [ ] Yes [ ] No
By signing the below section, you are agreeing the above listed availability, scheduling, and attendance. Secureone will write the schedule to fit inside of the above listed criteria. Employee Name: Date: Employee Signature: 1
2
1
X
X
X
X
X
6am until end
6 until
6- until
6- until
6- until
X
X
X
X
Searcy R Henderson