(1) FLEXIBLE Flexible working application form

[Company name]

Flexible Working Application Form

If you wish to make a request to the Company to alter your working arrangement please complete this form and return it to [your Manager]. This information will be used to help the Company process your request [and to monitor the Flexible Working Policy].

Name                         _____________________________________

Department                _____________________________________

Position                       _____________________________________

Date employment

commenced               _____________________________________