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

SECTION 5 – ADDITIONAL INFORMATION (To be completed by the requesting staff member)continued:What is the likely impact upon the work unit and other staff if the flexible working arrangement isapproved? Who will be affected and how?………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………Do you have any suggestions for how the impact of the requested flexible working arrangement onyour work role and/or the work role of others can be addressed?………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………What advantages/disadvantages (including any additional cost) does this requested flexibleworking arrangement involve?………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………What other arrangements have you considered? Would you be prepared to move to another role ifnecessary to accommodate the request for the flexible working arrangement and, if so, what roledo you consider you could be considered for taking into account your skills and experience?………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………If you are requesting a flexible working arrangement to accommodate your parental responsibilities:• is your child/children of pre-school age? □ Yes □ No• is your child/children under 18 years with a disability? □ Yes □ NoDo you have any other comments that you wish to have taken into consideration? (Detail on aseparate sheet if needed.)………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………SECTION 6 – ACKNOWLEDGMENT OF STAFF MEMBER1. I declare that the information I have provided is accurate.2. Notwithstanding any representation to the contrary, I acknowledge that the Universitymay refuse to approve my request for a flexible working arrangement on reasonablegrounds.3. I acknowledge that this request is conditional upon and subject to approval of anauthorised officer of my faculty/division and approval and confirmation by an officer of