Flexible Working Policy and Procedure - West Hertfordshire ...
Flexible Working Policy and Procedure - West Hertfordshire ...
Flexible Working Policy and Procedure - West Hertfordshire ...
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
APPLICATION FORM FOR FLEXIBLE WORKING<br />
Appendix 1<br />
Name:……………………………………………<br />
Department:…………………………………….<br />
Job Title:…………………………………….…<br />
Start Date:…………….…………………………<br />
Date of Request:………………………………<br />
Dependant’s Name:…………………………..<br />
Relationship to Dependant:…………………<br />
Child’s Date of Birth:…………………………..<br />
Is the request for a permanent or temporary change: Permanent<br />
Temporary<br />
Date of requested change to commence from:…………………………<br />
Change Current working pattern Requested working pattern<br />
Hours per week<br />
Times of work<br />
Place of work<br />
Please detail the effect you feel the proposed change will have on your ward / colleagues<br />
………………………………………………………………………………………………………<br />
………………………………………………………………………………………………………<br />
………………………………………………………………………………………………………..<br />
Please give details of how this can be addressed.<br />
………………………………………………………………………………………………<br />
………………………………………………………………………………………………<br />
………………………………………………………………………………………………<br />
Employee signature:………………………………<br />
Date:……………………………………<br />
Manager to complete:<br />
Date of meeting with employee:………………………<br />
If yes, commencement date:………………………….<br />
Managers Signature:………………………………….<br />
Request approved: Yes / No<br />
Change of Circumstance completed: Yes / No<br />
Date:…………………………………………….<br />
Page 8 of 9
Change language