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Flexible Working Hours Request Form Template
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This form is for employees to submit official requests for flexible working arrangements. All information you provide will be kept confidential and processed by the HR department within 5 working days. Please fill in accurate information based on your actual situation.
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1. Your full name
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2. Your employee ID
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3. Your current department
Choose
Human Resources
Finance
Marketing
Sales
Product Development
Engineering
Operations
Customer Service
Research and Development
Administration
Legal
Other
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4. Your current job title
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5. Your contact phone number
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6. Your work email address
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7. Which type of flexible working arrangement are you requesting
Fully remote working (all work performed off-site)
Hybrid working (combination of in-office and remote work)
Compressed work week (fewer longer days instead of standard 5-day work week)
Flexible core hours (adjustable start/end times while required to work during agreed core hours)
Job sharing (share one full-time position with another employee)
Reduced working hours (part-time schedule)
Other
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8. Requested start date of the flexible working arrangement
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9. Requested end date of the flexible working arrangement
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10. What are the primary reasons for your flexible working request (select all that apply)
[Choose at least 1 item]
Family caregiving responsibility (child, elder or other dependent family member)
Personal health and wellness needs
Long commute time and transportation difficulties
Improving overall work-life balance
Increasing personal work productivity
Educational or professional training commitments
Relocation planning
Long-term personal arrangements
Other
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11. Please describe your proposed flexible working schedule in detail
For example: specify core working hours, working location split, weekly hour distribution etc.
12. Please upload any supporting documents for your request (if applicable)
Upload at most 3 files
Acceptable files include medical certificates, caregiving proof, or other relevant documents. Maximum 3 files, total size under 10MB.
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