Flexible Work Arrangement Request Form

Section 1: Employee and Position Information

Employee Name:

Employee ID:


Department/Team:

Current Position/Job Title:


Date of Hire:

Direct Manager's Name:


Contact Phone Number:

Work Email Address:

Section 2: Current Working Arrangement Details

Please describe your current standard work schedule (e.g., Monday to Friday, 9:00 AM – 5:00 PM, 35 hours per week, office-based).


Current Standard Hours per Week:

Current Standard Schedule (Days/Times):

Current Location of Work:

Section 3: Requested Flexible Work Arrangement

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):


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):

Section 4: Rationale and Impact Assessment

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)

Section 5: Employee Declaration and Signature

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 and HR Review Section (DO NOT FILL)

Management Recommendation

Approved


Rationale for Decision:

Manager's Signature:

HR Approval

Approved

HR Notes:

HR Signature:

Form Template Insights

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Detailed Insights into the Flexible Work Arrangement Request Form

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:

Section 1: Employee and Position Information

This section establishes the context of the request.

  • Purpose: To easily identify the employee, their role, and their direct reporting structure. This is crucial for routing the request to the correct manager and HR personnel, and for cross-referencing against internal eligibility requirements (e.g., minimum tenure).
  • Key Insight: Inclusion of the Direct Manager's Name ensures the request follows the proper chain of command, acknowledging that the immediate manager has the best understanding of the role's day-to-day requirements and team dynamics.

Section 2: Current Working Arrangement Details

This section sets the baseline against which the proposed change will be measured.

  • Purpose: To document the existing standard agreement (hours, schedule, location). This clarifies exactly what is being changed and helps prevent future disputes or misunderstandings about the starting point.
  • Key Insight: It emphasizes that there is a default, standard arrangement, highlighting that the flexible arrangement is a modification requiring formal approval, not an entitlement.

Section 3: Requested Flexible Work Arrangement

This is the core of the request, detailing the proposed change.

  • Purpose: To clearly define the type of flexibility sought (Flex-Time, Remote, Compressed Week, etc.) and the precise terms of the proposed new schedule.
  • Key Insight:
    • The "Type of Arrangement Requested" checklist helps standardize the terminology used in HR records.
    • The inclusion of a "Proposed End Date" is vital. It allows for requests to be temporary (e.g., parental leave return transition) or structured as a formal trial period (e.g., 6 months), after which both parties can evaluate its success.

Section 4: Rationale and Impact Assessment

This is the most critical section for approval, as it shifts the focus from the employee's needs to the organization's needs.

4.1 Rationale for Request

  • Purpose: Provides the "why." While the reason may be personal (e.g., work-life balance), articulating it helps HR understand the severity and permanence of the employee's need.
  • Key Insight: A well-articulated, professional rationale can significantly strengthen the request, demonstrating that the employee has seriously considered the commitment.

4.2 Business Impact Assessment

  • Purpose: Requires the employee to proactively address potential concerns. This forces them to think like a manager, anticipating how the change might affect their performance and the team. This shows ownership and responsibility.
  • Key Insight:
    • Impact on Team/Internal Collaboration: This addresses the "A-synchronicity" risk. The employee must show they have a plan for being available during critical "core" hours or for managing handovers.
    • Impact on Client/Stakeholder Service: This ensures that client-facing roles do not compromise service delivery. The plan must show how accessibility will be maintained.
    • Technology/Resources: This flags any necessary IT support or equipment provision before approval, preventing delays in implementation.

Section 5: Employee Declaration and Signature

This section formalizes the employee's commitment.

  • Purpose: The declaration signifies that the employee understands the company's policies, confirms the accuracy of the request, and agrees to maintain performance standards.
  • Key Insight: It explicitly notes that an approved arrangement is conditional ("may be revoked or modified based on business needs or performance issues"). This is a necessary legal and HR safeguard, confirming that the business retains the ultimate right to determine staffing models.

Management and HR Review Section

This is the Organizational Response section.

  • Purpose: This structured review process ensures consistency and fairness in decision-making. The manager provides the operational assessment, and HR provides the policy/legal assessment.
  • Key Insight: By requiring separate Manager Recommendation and HR Final Decision, the form enforces a crucial check-and-balance system. The manager is focused on feasibility (can the work get done?), while HR is focused on policy compliance (is the decision equitable and non-discriminatory?). Rationale for a denial or modification must be documented, which is essential for transparency and legal compliance.


Mandatory Questions Recommendation

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Mandatory Questions on the Flexible Work Arrangement Request Form

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:

1. The Core Request: Section 3

Mandatory Fields:

  • 3.1 Type of Arrangement Requested: (e.g., Flex-Time, Remote/Telework, Reduced Hours)
  • 3.2 Proposed Work Schedule (Days/Times):
  • 3.2 Proposed Total Hours per Week/Month:
  • 3.2 Proposed Work Location(s):
  • 3.2 Effective Start Date (Proposed):

Elaboration:

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.

  • The Type of Arrangement dictates which specific company policies must be applied.
  • The Schedule, Hours, and Location form the basis of the new employment agreement. These details are critical for scheduling, payroll processing, legal compliance regarding working hours, and defining the employee's physical accessibility for the team.

2. Identification and Context: Section 1 & 2

Mandatory Fields:

  • Employee Name & Employee ID: (Section 1)
  • Current Position/Job Title: (Section 1)
  • Direct Manager's Name: (Section 1)
  • Current Standard Hours per Week & Schedule: (Section 2)

Elaboration:

These fields establish "Who" is requesting the change and the "Baseline."

  • Identification: Employee and Manager names are necessary for official record-keeping, policy eligibility checks, and to initiate the workflow (sending it to the correct manager).
  • Position/Job Title: Certain roles (e.g., those requiring high physical presence or handling sensitive materials) may have inherent limitations on flexibility, making the role title essential for feasibility review.
  • Current Schedule: This is mandatory because without knowing the starting agreement, it is impossible to define the difference or the extent of the proposed change.

3. Justification and Impact: Section 4

Mandatory Fields:

  • 4.1 Rationale for Request:
  • 4.2 Business Impact Assessment (All sub-sections):

Elaboration:

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.

  • Rationale: While the company cannot legally deny a request solely based on the personal reason (in many jurisdictions), understanding the rationale informs the permanence and urgency of the request. It also helps HR identify if the request falls under specific legal protections or company programs (e.g., disability accommodation, caring responsibilities).
  • Business Impact: This is arguably the most critical section for the organization. By mandating the employee to detail the impact on Team/Collaboration and Client Service, the company ensures that the employee has considered the operational feasibility. A request that does not address how business continuity will be maintained cannot be responsibly approved.

4. Accountability and Compliance: Section 5

Mandatory Fields:

  • Employee Signature:
  • Date of Submission:

Elaboration:

This section provides the necessary legal and procedural commitment.

  • Employee Signature: This is mandatory as it represents the employee's formal acceptance of the terms and conditions outlined in the form, including the commitment to maintain performance and the understanding that the arrangement is conditional and subject to review/revocation. Without a signature, the document is just a proposal, not a formal request.
  • Date of Submission: Essential for tracking compliance with policy timelines (e.g., if a request must be submitted 4 weeks in advance) and for setting the review/approval schedule.


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