In California, many employees are required to complete Form W-2, which is the Wage and Tax Statement. This form is used to report wages, salaries, tips, and other compensation paid to an employee during the calendar year. The purpose of this blog post is to provide an overview of the California work week agreement form. Please note that this information is not intended as legal advice. If you need specific legal advice, please contact an attorney. In general, employees in California are considered " exempt" if they meet certain criteria outlined in the Fair Labor Standards Act (FLSA). One such criterion is that they are paid on a salary basis and their duties are primarily managerial or executive in nature. If you are an exempt employee in
| Question | Answer |
|---|---|
| Form Name | California Work Week Agreement Form |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | alternative agreement workweek california form, alternative work schedule agreement form california, calhr183, california alternate week agreement |
Alternate Work Week Agreement
California Department of Human Resources
State of California
1. Employee Information
Employee Name
Division
2. Alternate Work Week Schedule
Position # |
Today's Date |
Effective Date
Please indicate which Alternate Work Week Schedule you are requesting (check one).
9/8/80 Work Schedule: • Regular Day Off (RDO): (Monday - Friday)
•Date of first RDO:
•Work schedule for
•Work schedule for
4/10/40 Work Schedule: • Regular Day Off (RDO): (Monday - Friday)
•Work schedule for
Other: Specify schedule and work hours:
If you are on a 9/8/80 Alternate Work Week Schedule, your work week for overtime purposes will start
In signing this agreement, and in accordance with the provisions of the FLSA, you agree to permanently maintain your agreed upon alternate work week schedule. Periodic changes will not be permitted unless you are placed on jury duty, military leave, or
This agreement may be cancelled at any time by either you or the Department. Failure to comply with the procedures as outlined in the CalHR Alternate Work Week Policy, including maintaining a minimum of 40 hours of leave credits or other paid leave (other than sick leave), will cause you to be removed from your alternate work schedule and return you to a normal Monday - Friday, 5/8/40 work week.
3. Approval
I have read and understand the above terms and conditions of the alternate work week schedule and understand that this agreement is made in accordance with the provisions of the FLSA. I also acknowledge receipt of CalHR's policy on Alternate Work Week Schedules and understand a copy of this agreement will be placed in my official personnel file for audit purposes. I further understand that any excess hours accrued as a result of this schedule will be compensated as straight time when paid by lump sum, and any deficit hours will be charged to vacation, holiday credit, excess hours, personal leave, annual leave, CTO or approved dock.
Employee Signature
Division Chief Signature
Supervisor Signature
Personnel Officer Signature
CalHR 183 |
Page 1 of 1 |
(rev 04/2016) |