Flexible Work Arrangements Request Template

The Flexible Work Arrangements Request Template empowers you to initiate a conversation with your boss about a different way of working. It’s a tool that puts you in control, providing a clear way to explain why you want to change your work setup.

First, you fill in your basic info, such as your name and job title. You also write down how you work now.
Then, you pick what kind of flexible work you want. It could be working from home, changing your hours, or working fewer days.

You share the reasons behind your desire for this change. It could be to better balance your family responsibilities or to enhance your productivity. We understand and empathize with your personal situation.

The template asks how this new setup will affect your work. It would help if you showed that you can still do your job well.
You also suggest how to measure the new arrangement’s success. This shows that you’re thinking about the company’s needs, too.

There’s a space for your boss to approve the request.

This template helps you make a strong, professional case for flexible work. It shows you’ve thought everything through carefully.

Download the Flexible Work Arrangements Request Template Word Document: 

Employee Information

• Name: ___________________________________________
• Job Title: ______________________________________
• Department: _____________________________________
• Date: ___________________________________________

Current Work Schedule

• Current Work Hours: _____________________________
• Current Work Location: __________________________

Requested Flexible Work Arrangement

Type of Flexible Arrangement Requested:

• Remote Work
• Flexible Hours
• Compressed Workweek
• Job Sharing
• Part-Time Work
• Other: ______________________________________

Details of the Requested Arrangement:

• Proposed Work Hours: ____________________________
• Proposed Work Location: _________________________
• Effective Start Date: ___________________________
• Duration of Arrangement: ________________________

Reason for Request

• Describe the reason for requesting this flexible work arrangement:
  

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Impact on Work and Colleagues

• How will this arrangement impact your work and productivity?
  

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• How will you ensure that work deadlines and responsibilities are met?
  

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• What steps will you take to communicate and collaborate with your team?
  

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Proposed Evaluation Plan

• How will the success of this arrangement be measured?
  

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• Suggested frequency of check-ins or reviews:
  

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Additional Notes

• Any additional information or considerations:
  

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Approval

• Manager’s Name: ____________________________________________
• Date of Approval: __________________________________________
• Signature: ________________________________________________

Remember: A well-documented request increases the likelihood of approval. Be clear, concise, and provide as much detail as possible to support your request.