This form can help employees who wish to request flexible work.
On this page:
All employers who receive a request must provide a written response within 21 days, which outlines whether the request is approved or refused. Employers can only refuse a request on reasonable business grounds, and must elaborate on these reasons in the written response. The template (below) can support employers to engage in conversation with their employees.
| Details | |
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| 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. |
| As discussed with you I have considered your request for a flexible working arrangement | Insert below the date of discussion
Click or tap to enter a date. |
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Current Work Arrangement |
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Current Place of Work: |
Click or tap here to enter text. |
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Current Days Worked: |
Click or tap here to enter text. |
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Current Hours Worked: |
Click or tap here to enter text. |
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Possible outcomes |
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1. As discussed with you, I can confirm that I have approved your request: |
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2. As discussed with you, I am unable to accommodate your original request: |
However, I am able to offer you the following arrangement which we have discussed and you stated would be suitable: Click or tap here to enter text. Your new arrangement will start: Click or tap to enter a date. |
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3. I am declining your request for the following reasons as discussed with you. We will review this agreement on a quarterly basis. |
Our next review date will be Click or tap to enter a date. |
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Signed: |
Sign here
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Name: |
Click or tap here to enter text. |
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Date |
Click or tap to enter a date. |