Staff Availability Survey
Employee Name
*
First Name
Last Name
Email
example@example.com
How many hours a week are you working?
Do you want extra hours
Yes
No
If yes, please select the days you're available to work
Yes
No
Time
Remarks
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Sunday
In case we need someone to work during weekends and we need the staff to do a rotational off, are you willing to work during weekends?
Yes
No
If yes, how often do you want to work on weekends?
Once a month
Twice a month
Thrice a month
Other
Are you flexible at work in terms of scheduling?
Yes
No
If we have a sleepover are you willing to work the shift?
Yes
No
Are you willing to do personal cares
Yes
No
Will consider if trained
Do you have any comments, suggestiosn or feedback?
Employee Signature
Date Signed
/
Day
/
Month
Year
Date
Submit
Submit
Should be Empty: