DRAFT Flexible Working Application Form You can use this form to make an application to the Company to work flexibly under the right provided in law. For further information on the statutory right to request a flexible working arrangement, please refer to the Company’s flexible working policy or speak to Jude Wild (Office Manager). You should note that it may take up to two months to consider and decide on a request, and possibly longer where you have agreed a longer decision period with the Company. You should therefore ensure that you submit your application to the Office Manager in good time and ideally two months before you would like the changes to your working arrangements to take effect. It will help the Company to consider your request if you provide as much information as you can about your desired working pattern. You can ask for changes to the number of hours you work, the times you work or the place you work. It is important that you complete all the questions as otherwise your application may not be valid. Once you have completed the form, you should immediately forward it to the Office Manager and you should keep a copy for your own records. The Company will then consider your request and may arrange a meeting with you to discuss it further. If your request is granted, this will constitute a permanent change to your terms and conditions of employment unless otherwise agreed with you. This means that you would not have the right to revert to your previous pattern of working at a future date. However, depending on the circumstances of the case, at its absolute discretion the Company may be willing to agree to a temporary change to your working arrangements (and hence also a temporary change to your terms and conditions of employment) for a specified period only. In that case, you would then revert to your previous pattern of working after the specified temporary period comes to an end.Full name(Required)DepartmentPlease detail your current working pattern (days/hours/times worked or place of work)(Required)Please describe the working pattern you would like to work in the future (days/hours/times worked or place of work)(Required)Date you would like the proposed new working pattern to start from:(Required)Have you made any previous formal applications to the Company for flexible working?(Required) Yes No If yes, please provide the dates of your previous applications in the last 18 monthsAre you making a request for a permanent or a temporary change to your working pattern?(Required) Permanent Temporary If “temporary” only, please specify the period you would like the change to last (for example, three months):Are you making your request as a reasonable adjustment for a disability under the Equality Act 2010?(Required) Yes No If yes, please provide any further relevant information that you would like the Company to consider:If no, if you wish to do so, please explain the reason for your request and include any other supporting information you think may be useful for us to consider (this is not obligatory):Consent(Required)I declare that the information I have given on this form is true. I understand that it is a serious disciplinary offence to provide false information on this form. I confirm that this is a statutory request for flexible working under my right provided in the Employment Rights Act 1996. I confirm that I have not made more than one other request to work flexibly under this statutory right during the past twelve months and that I do not currently have another live request for flexible working with the Company. By ticking this box, I confirm that the declaration above is trueDate(Required) DD slash MM slash YYYY
