Flexible Work Arrangement Form

Flexible Work Arrangement Form

Please complete the following information to request a flexible work arrangement.

Employee Information

Employee Name

    Employee ID

      Position Title

        Department

          Manager/Supervisor

            Date of Request

              Proposed Flexible Work Arrangement

              Requested Start Date

                Requested End Date

                  Type of Arrangement

                    • Remote Work

                    • Hybrid Work

                    • Flexible Hours

                    Please provide a brief explanation of your reasons for requesting this arrangement and how it will benefit your productivity and work-life balance

                      Employee Agreement

                      By signing below, I acknowledge and agree to the following terms:

                      • I understand that this arrangement is temporary and may be subject to periodic review.

                      • I agree to fulfill my job responsibilities and meet performance expectations under this arrangement.

                      • I acknowledge that any breach of this agreement or company policies may result in revocation of the flexible work arrangement.

                      Date:

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