Flexible Working Request Letter
  • Flexible Working Request
    • Who is Employee?
    • Who is Employer?
    • Change of Working Hours
  • Complete the Document
    • Format & Signatures

Who is Employee?

  • Indicate an Employee's full name (i.e. this a person who wants to request flexible working hours):

  • Indicate an Employee's full residential address:

  • Indicate an Employee's current job title:

  • Indicate an Employee's contact email address:

    !

    This email address can be used by the employer in order to reach an employee to discuss further details of a possible flexible working schedule.

  • Indicate a period of time (in days, weeks or months) during which an Employee works with the company:

Who is Employer?

  • The Employer is:

  • Indicate an Employer's full name:

  • Indicate the Employer's company full name:

  • Indicate an Employer's full address:

  • Indicate a name of a person to whom this letter will be addressed:

    !

    This is usually a name of a company’s CEO or head of HR department who is in charge of employees’ working schedule.

Change of Working Hours

  • Does an Employee already know how their new flexible working schedule should look like?

  • Describe in detail how exactly the new flexible working schedule should look like:

  • The new flexible working schedule should be established for:

  • Indicate a period of time (in days, weeks, or months) for which an Employee wishes to request flexible working hours:

  • Describe in detail why an Employee wishes to request a flexible working schedule:

    !

    While neither federal nor state laws limit an employee’s right to have a flexible working schedule, understanding the reasons behind such a decision always helps employers.

    An employee may request flexible working hours in the following circumstances, for example:

    – pregnancy, maternity leave, or sickness of a child;
    – employee’s immediate family members have health problems;
    – commute issues;
    – other family circumstances.

  • Has an Employee had any warnings or discipline issues with their Employer in the past?

    !

    Warnings or discipline issues at the workplace may include the following:

    – bullying or workplace harassment;
    – constant lateness;
    – insubordination; or
    – discrimination of other co-workers, etc.

  • If a flexible working schedule is approved, an Employee wants to work from:

  • Indicate the name and address of another venue or place from where an Employee wishes to work if their flexible working schedule is approved:

  • Indicate the date on which an Employee signs this letter:

  • Do you want to add a signature?

  • Employee's signature:

Select a document's format:

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