Employee Availability Confirmation

EMPLOYEE AVAILABILITY CONFIRMATION

Personal Information

Position Information

Expected Start Date:    Salary / Rate:

Availability Details

Please indicate the days you are available to work (check all that apply):

Monday   Tuesday   Wednesday   Thursday   Friday   Saturday   Sunday

For each day you intend to work, provide your typical available start and end times:

From to

From to

From to

From to

From to

From to

From to

Shift preferences (check all that apply):  Morning   Afternoon   Evening   Night/Overnight

Availability effective from through (if applicable)

Are you available to work on company-designated holidays?   Yes    No

Are you willing to work overtime if required?   Yes    No

Remote work availability:   Yes    No

Employment History

From to

From to

Education

Professional References

Legal Disclosures and Authorizations

At-Will Employment: I understand and acknowledge that, if hired, my employment is at-will and may be terminated by either party at any time, with or without cause or prior notice, unless otherwise expressly provided in a written agreement signed by an authorized representative of the employer.

Equal Opportunity: The employer provides equal employment opportunity without regard to race, color, religion, sex, national origin, age, disability, or any other characteristic protected by applicable law.

Authorization to Contact: I authorize the employer and its designated representatives to contact my references and prior employers to verify information provided and to obtain information related to my employment history, attendance, performance, and other job-related information.

Background Check Consent: I acknowledge that employment may be contingent upon the employer's receipt of satisfactory results from background checks, which may include criminal history, motor vehicle record, and verification of education and employment. By checking the box below I expressly consent to such checks.

I authorize and consent to the employer conducting background checks and contacting prior employers and references as described above.

Certification of Accuracy: I certify that all information provided in this form is true and complete to the best of my knowledge. I understand that falsification, omission, or misrepresentation of information may result in rejection of this application or termination of employment.

Acknowledgement of Schedule Changes: I understand that shift schedules and work assignments may change based on business needs. I agree to provide reasonable notice of changes to my availability and to remain flexible when operationally required.

Applicant Certification and Signature

I hereby certify that the availability information provided on this form is accurate and complete. I understand that this document will be used to schedule me and assess eligibility for available shifts. I agree to notify the employer promptly of any changes to my availability.

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