Employee Name:
Employee ID:
Department/Team:
Current Position/Job Title:
Date of Hire:
Direct Manager's Name:
Contact Phone Number:
Work Email Address:
Please describe your current standard work schedule (e.g., Monday to Friday, 9:00 AM β 5:00 PM, 35 hours per week, office-based).
Current Standard Hours per Week:
Current Standard Schedule (Days/Times):
Current Location of Work:
Please describe the specific flexible work arrangement you are requesting. Check the primary type and fill in the details.
3.1 Type of Arrangement Requested (Check all that apply):
Flex-Time: Variation in start/end times while maintaining daily/weekly hours.
Compressed Work Week: Working full-time hours in fewer than five days.
Part-Time/Reduced Hours: Reduction in the total number of hours worked per week/month.
Remote/Telework: Working from a location other than the standard office.
Job Sharing: Sharing the responsibilities of one role with another employee.
Other:
3.2 Specific Proposed Arrangement
Effective Start Date (Proposed):
Proposed Work Schedule (Days/Times):
Proposed Total Hours per Week/Month:
Proposed Work Location(s): (e.g., Home, Office, Hybrid (3 days office, 2 days remote)
Proposed End Date (If applicable for a trial or temporary request):
4.1 Rationale for Request
Please explain the primary reason for your request (e.g., to improve work-life balance, manage personal/family commitments, reduce commute time, focus work, etc.).
4.2 Business Impact Assessment
Please detail how you intend to ensure that the proposed arrangement will maintain or improve your productivity, meet performance expectations, and effectively serve the needs of your team, department, and clients/stakeholders.
Impact on Team/Internal Collaboration: How will communication/meetings be managed?
Impact on Client/Stakeholder Service: How will accessibility be maintained during core business hours?
Technology/Resources: Do you have the necessary equipment/setup to perform your duties under the new arrangement? (Insert Business Impact Details Below)
I confirm that I have read and understood the relevant company policies regarding Flexible Work Arrangements. I certify that the information provided in this request is accurate, and I commit to fulfilling my job duties and maintaining the agreed-upon standards of performance, communication, and attendance if this request is approved. I understand that any approved arrangement may be subject to a review period and may be revoked or modified based on business needs or performance issues.
Employee Signature:
Management Recommendation
Approved
Rationale for Decision:
Manager's Signature:
Approved
HR Notes:
HR Signature:
Form Template Insights
Please remove this form template insights section before publishing.
This Flexible Work Arrangement Request Form is designed to serve as a structured tool for both the employee and the organization. It ensures that the request is comprehensive, the rationale is clear, and the potential business impact is fully considered before a decision is made.
Here are detailed insights into the purpose and importance of each section:
This section establishes the context of the request.
This section sets the baseline against which the proposed change will be measured.
This is the core of the request, detailing the proposed change.
This is the most critical section for approval, as it shifts the focus from the employee's needs to the organization's needs.
This section formalizes the employee's commitment.
This is the Organizational Response section.
Mandatory Questions Recommendation
Please remove this mandatory questions recommendation before publishing.
In the provided form, virtually every field in Sections 1 through 5 is considered mandatory for the request to be actionable and compliant. Failing to complete these specific fields would make it impossible to properly process, evaluate, or approve the arrangement.
Here are the key mandatory questions/fields and a detailed elaboration on why they are essential:
These are the "What, When, and Where" of the request. Without these, the organization does not know what is being asked for, which makes the form null and void.
These fields establish "Who" is requesting the change and the "Baseline."
This is the "Why and How" of the request. These sections are mandatory because approval is contingent on showing that the arrangement is mutually beneficial or sustainable for the business.
This section provides the necessary legal and procedural commitment.