Flexible Work Application Form

The Fair Work Ombudsman requires that requests for flexible work are delivered to the employer in writing to ensure clarity on agreements and adherence to legal requirements.

The template below will help aid employees who wish to request flexible work:

Flexible Work Application Form
Full name: Click or tap here to enter text.
Date: Click or tap to enter a date.
Job Position Click or tap here to enter text.
Team: Click or tap here to enter text.
Employer Name: Click or tap here to enter text.

Current Work Arrangement

Current Place of Work: Click or tap here to enter text.
Current Days Worked: Click or tap here to enter text.
Current Hours Worked: Click or tap here to enter text.

Proposed Flexible Working Arrangement

Part-time ☐
Working from home ☐
Job Share ☐
Flexi Time ☐
Other: ____________________________ ☐
Phased Retirement ☐
I would like the new arrangement to be permanent and start from:(day, month, year) Click or tap to enter a date.
I would like the new arrangement to be temporary:

Start date

Click or tap to enter a date.

End date

Click or tap to enter a date.
Reason for the request: (optional) Click or tap here to enter text.

I believe the proposed arrangement may lead to the following benefits and barriers:

  Benefits Potential Barriers
Myself: Click or tap here to enter text. Click or tap here to enter text.
Business: Click or tap here to enter text. Click or tap here to enter text.
Team: Click or tap here to enter text. Click or tap here to enter text.
Customer: Click or tap here to enter text. Click or tap here to enter text.
I suggest we could fix the potential barriers by: Click or tap here to enter text. Click or tap here to enter text.
Signed: Sign here Sign here
Name: Click or tap here to enter text. Click or tap here to enter text.
Date Click or tap to enter a date. Click or tap to enter a date.

Download the Flexible Work Application template.

Workplace flexibility

Use workplace flexibility to support diverse and innovative workforces.
What is flexible working?

Flexible work is most commonly defined by what it is not – not the 9 to 5, central office arrangement.
Maturity assessment

Understanding the context and maturity of your business is a crucial first step in integrating flexible working arrangements.
Guidance for managers

Managers are critical enablers of workforce flexibility, serving as the bridge between policy and practice.
Additional Resources

Apps that support flexible working.