Flexible Working Arrangements Request Form - Adm.monash.edu.au

SECTION 4 – SCHEDULE PROPOSED (Provide details of the schedule proposed where this isrelevant to the request)MondayTuesdayWednesdayThursdayFridayTotal fortnight/weekly hoursHours/times Location SpecialArrangementsIf you are an academic staff member and your proposed schedule involves a reduction in your workfraction, what is your anticipated proportionate allocation of research, education and serviceactivities during the period of your reduced work fraction?Research_____%Education_____%Service_______%SECTION 5 – ADDITIONAL INFORMATION (To be completed by the requesting staff member)If applicable, what is the nature of your carer and/or parental responsibilities and to whom do theyrelate?………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………What are your duties and your work role and what is the likely impact upon your duties and yourwork role if the flexible working arrangement is approved?………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………