NOTE TO THE EMPLOYEE – THIS FORM MUST BE COMPLETED FULLY
NOTE TO THE LINE MANAGER
This is a formal application made under the legal right to apply for flexible working and the duty on an employer to consider an application seriously. Please also refer to the Guidelines for a Flexible Working Request
You have 28 days fromthe day you received this application in which to either agree to the request or arrange a meeting with your member of staff to discuss their request. Please contact the Human Resourcesfor guidance before you approve this request.You should confirm receipt of this application using the attached confirmation slip.
1. EMPLOYEE DETAILS
Name: / Emp. Ref. No.:
Line Manager: / NI No.:
Employment Start Date: / Date Form Submitted
Previous Applications for Flexible Working
Have you submitted a previous request for flexible working? (if yes, please answer the next question) / Yes / No
When did you submit your last request for flexible working?
TO THE LINE MANAGER
1.I would like to apply to work a flexible working pattern that is different to my current working pattern under my right providedin law. For the following reasons. (Please note you are not obliged under the new legislation to give a reason, however it may assist us in looking at your case).
I wish to submit a statutory request for flexible working as detailed below.
2a. Describe your current working pattern (days/times worked):2b. Please set out the pattern of working that you are seeking. For example, if you wish to change your hours of work, please state what you would like your new hours to be or, if you wish to work at home at certain times, please state which hours you would like to work at home.
(You may continue on a separate sheet if necessary)
2c. I would like this working pattern to commence from:
3. Please state the effect that you think the changes you are requesting will have on the organisation’s ability to run its business and on your department, your colleagues etc.
4 Please state how you think any such effect might be dealt with.
Signed:
Date:
Note.
Once you have submitted a valid application for flexible working, your line manager will contact you to arrange a meeting, which will take place within 28 days of the application being submitted, to discuss how the pattern of working you have requested might be made to work. If your request is granted the new legislation means that the changes made can now be ‘subject to review’ or ‘a right to end the arrangement.’
It will help us to deal with your application if you provide as much information as you can about your desired working pattern. It is also important that you complete the questions about the effects that you think the changes you are requesting will have on the organization and your colleagues.
Please send this application to your line manager and copy it to Human Resources or alternatively send a copy to Human Resources. The Human Resources copy will be only used for monitoring the take-up of flexible working requests by staff.
Line manager’s confirmation of receipt (to be completed and returned to the employee)Dear
I confirm that I received your request to change your working pattern on (date):
I shall be arranging a meeting to discuss your application within 28 days following this date. In the meantime you might want to consider whether you would like a work colleague or trade union representative to accompany you to the meeting.
Signed: Date: