Agreement form to accept night work

THIS AGREEMENT is made the [Enter Day] day of [Enter Month] year [Enter Year]

A second shift is or may be required to meet our present or future needs. All new employees are hired on the understanding that they are able and willing to work night shifts.

Please answer the following:

 

 

Yes

No

1.

Do you have any physical disability that would prevent you from working night shifts?

___

___

2.

Do you know of any personal reasons that would interfere with your working night shifts

___

___

3.

Are you willing to work night shifts?

___

___

I understand that any employment is conditional upon my acceptance of a night assignment if required.

____________________________________
Signed

 

____________________________________
Date

 

____________________________________
Witness

In case of emergency notify:

Name

Telephone

Address

Relationship

 

 

 

 

Name

Telephone

Address

Relationship

Note: there are certain obligations that employers must comply with under the Working
Time Regulations 1998 when engaging night workers.