Flexi Worker

First Name (Required):

Second Name (Required):

Company (Required):

Current Work Pattern (Required):

Requested Change (Required):

Details of Requested Change (Required):
Describe exactly what kind of change you would like. State the hours or start times etc.

Start Date (Required):
When you want the changes to start.

Appeal:
You can strengthen your appeal by explaining why you want flexible working and explaining how the request won't harm the business. If it could be beneficial to the business then make sure you include this in your appeal.

Do you have any disabilities, or physical or mental health conditions (Required):

Reasonable adjustments for disabilities or health conditions:
If you have disabilities, or physical or mental health conditions, describe the nature of your condition and how flexible working would help your situation. This greatly strengthens a request.

Have you made any previous requests for flexible working (Required):

Date of Last Request:
When you made your last flexible working request.