APPENDIX C
ANNUAL REQUEST FORM
PROMOTION, CHANGE IN DUTY, CHANGE IN BUILDING/CHANGE IN HOURS
SCHOOL YEAR 20____ -20
Name: Date:
Please Print
Present Position: School:
Current Hours Worked Per Day:
PRESENT TIER: I "ol
If you do not desire any changes in your hours, present position or work location, please check here:
| WISH TO REMAIN IN MY PRESENT POSITION WITH THE SAME HOURS AND AT THE SAME
SCHOOL.
Request for change and Preferences desired:
(Specify position(s), hours and school(s) you would be willing to accept if it becomes available.]
School(s) Please list individual schools Position(s} Please circle all that apply.
separately on the blank lines below in
order of preference:
Any school Elementary Cook
Middle School Cook
High School Cook
Lead Cook
Food Service Assistant
Do you wish to be offered additional hours, if they become available, during the year?___—Yes__—s Noo
Please indicate the earliest start time and the latest release time that you
could work,
This form may be submitted at any time. Requests are valid through the school year in which the form is filed.
New requests must be submitted each school year. This form shall be incorporated into the letter of intent form
and be distributed to all employees. New employees shall be given a copy of this form upon their hiring.
Employees may update this form as they deem necessary throughout the year.
Signature of Employee
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