Flexible Working Request Form

Flexible Working Request Form

You can use this form to make an application to work flexibly under the right provided in law to eligible employees.
Before completing this form, read the guidance on the right to request flexible working on GOV.UK, and check that you are eligible to make a request - https://www.gov.uk/flexible-working

You should note that under the right it may take up to 2 months for us to consider a request and possibly longer where you have agreed to a longer decision period with us. You should therefore ensure that you submit your application in advance of the date you wish the request to take effect.

It will help us to consider your request if you provide as much information as you can about your desired working pattern. It is important that you complete all the questions as otherwise your application may not be valid. When completing questions 3 and 4, think about what effect your change in working pattern will have both on the work that you do and on your colleagues.

If the request is granted, this will be a permanent change to your terms and conditions unless otherwise agreed.
1. Name*

First NameLast Name
Email Address*
example@example.com
Line Manager*

First NameLast Name
Line Managers Email Address*
example@example.com
Dates of any previous request to work flexibly under this right:

DayMonthYear
Date
2a. Describe your current working pattern (days/hours/times worked):*
2b. Describe the working pattern you would like to work (days/hours/times): *
2c. I would like this working pattern to commence from:*

DayMonthYear
Date
2d. I envision this pattern to last for:*
Signed*

Clear
Date*

DayMonthYear
Date
Please verify that you are human*
Should be Empty: