Request For Flexible Working Form Instructions Both Employees And

request for flexible working form instructions: both employees and line managers should read the flexible working policy & procedure

Request for Flexible Working Form

Instructions: Both employees and Line Managers should read the
Flexible Working Policy & Procedure document before completing any
section of this form.
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1.
2.
Section 1 (to be completed by employee)
3.
Employee Details
Name:
 
School/Institute/Department:
 
Job Title:
 
Start date of employment at QMUL:
 
Continuous service of 26 weeks or more?
Yes No
Request Details
The change I am applying for is to:
(please tick all that apply)
change the hours I work
change the times I work
work from home
The date I want the change to start is:
 
I would like the following permanent changes made to my contract:
 
I consider that such a change would have the following effects on
service:
 
I consider that any adverse effects could be dealt with as follows:
 
Please provide below any details (including dates and change
requested) of any previous flexible working requests:
 
N.B. You can take advice from your union on how to complete the above
section or talk it through informally with you line manager
Monitoring for Equality
My employee number is:
 
Signature and Declaration
I declare that:
this is my only application under this procedure in the last 12 months
the details I have given are accurate to the best of my knowledge
Signature:
Date:
 
Section 2 (to be completed by Line Manager)
Decision Details
Date request received:
 
Date of meeting:
 
Decision:
Permanent change agreed
Permanent change agreed pending trial period (provide details in box
below)
Permanent change not agreed
Please outline below the reasons for the decision and set out the
factors considered (if the request was not approved please specify
against which business grounds you have rejected the request):
 
If approved please confirm date on which the change will be
implemented:
 
Name:
 
Signature:
Date:
 
Section 3 (to be completed by manager hearing the appeal)
Appeal Details (if relevant)
Date appeal received:
 
Date of appeal:
 
Decision:
Permanent change agreed
Permanent change agreed pending trial period (provide details in box
below)
Permanent change not agreed
Please outline below the reasons for the decision and set out the
factors considered (if the request was not approved please specify
against which business grounds you have rejected the request):
 
Name:
 
Signature:
Date:
 
2
July 2014