On Call Employee Availability Form

On Call Employee Availability Form

Purpose: Use this form to document and maintain current on-call availability, response expectations, restrictions, and emergency contacts. Completion of this form does not alter the at-will nature of employment where applicable. Submit updates promptly when your availability or contact information changes.

Personal Information

Position Information

On-Call Availability (Weekly)

Indicate all days and time ranges you are willing and able to be on-call. When available, specify the typical start and end times. If availability varies week to week, indicate common patterns and note exceptions in the Unavailable/Blackout Dates section below.

On-Call Response Commitments and Restrictions

By submitting this form, the employee acknowledges and agrees to the following terms regarding on-call duties. These operational requirements apply when scheduled or designated as on-call by management.

1. Response Time: I agree to be reachable at the contact numbers and to respond to on-call notifications within .

2. Mobility and Equipment: I certify that I have reliable transportation and will carry an operational phone when on-call. If required to travel to a work site, I can arrive within .

3. Overtime and Compensation: I understand compensation for on-call work, emergency callbacks, and minimum reporting or call-out guarantees will be provided in accordance with company policy and applicable law. Questions about rates should be directed to Human Resources or payroll.

4. Restrictions and Accommodations: Indicate any restrictions (medical, legal, or other) or scheduling accommodations that affect your ability to be on-call.

Unavailable / Blackout Dates

List any dates or date ranges during which you are not available for on-call assignment (vacation, medical leave, pre-scheduled events). Updates must be submitted as soon as practicable.

Emergency & Backup Contacts

Employment History (Most Recent First)

Provide at least two prior employers. Include duties and reason for leaving.

Education

Professional References (Three)

Provide three professional references familiar with your work history and work performance.

Legal Disclosures & Authorizations

At-Will Employment: I acknowledge that, unless I have an express written agreement to the contrary signed by an authorized company representative, my employment remains at-will, which means either I or the employer may terminate the employment relationship at any time, with or without cause or notice.

Equal Opportunity: The employer is an equal opportunity employer. Employment decisions are made without regard to protected characteristics, and reasonable accommodations are considered where required by law.

Authorization to Contact and Background Checks: I authorize the employer and its agents to contact my prior employers and listed references to verify the information provided and to obtain work history. I further authorize the employer to obtain background, criminal, motor vehicle, and other employment-related reports where permitted by law. I understand that continued employment, assignment to on-call duties, or participation in certain on-call operations may be contingent upon satisfactory results.

Applicant Certification

I certify that the information provided on this form is true and complete to the best of my knowledge. I understand that falsification, omission, or misrepresentation of facts may result in denial of on-call privileges, disciplinary action, or termination of employment. I agree to promptly notify my manager and Human Resources of any changes to my availability or contact information.

Additional Notes

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