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

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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
Monash HR acting for the Executive Director, Monash HR, on behalf of the UniversityCouncil.4. If applicable, I acknowledge that the request for a flexible work fraction is for anagreed period and that the University is under no obligation to continue thisarrangement beyond the agreed period. Upon the expiry of this agreed period Iacknowledge that I will return to my substantive work fraction.5. I acknowledge that if the University has agreed to approve my flexible workingarrangement by adopting the proposed schedule contained in section 4 of thisapplication for an agreed period or time, that at the expiration of the agreed period theUniversity is under no obligation to continue this arrangement. Upon the expiry of thisagreed period I acknowledge that I will return to my existing work schedule in mysubstantive position unless otherwise agreed.Signature of ApplicantSignature Please print name Date__ / __ / ______Contact Extension No.Note: If the request is approved the new arrangements will be in accordance withconditions of employment as provided with your existing contract of employment.Employment guidelines and policies may be found in the Workplace Policies andprocedures at http://adm.monash.edu/workplace-policy/ as varied from time to time.SECTION 7- AUTHORISATIONAuthorisation 1 - Head of UnitSignaturePlease print nameAuthorisation 2 – Required if approving unpaid leaveof greater than 6 monthsDeputy Vice-Chancellor (Education)for academic staff/ Vice-President Administration for non-academic staffSignaturePlease print nameContact Ext No. __ __ __ __ __ Date __ __ / __ __/ __ __ Contact Ext No. __ __ __ __ __ Date __ __ / __ __/ __ __FORM TO BE RETAINED ON STAFF MEMBER’S PERSONNEL FILE BY HR OPERATIONSFOR MONASH HR USE ONLYFor assistance please contact Access HR on 9902 0400Processed by Date / / Checked by Pay PeriodMonash HR privacy collection statement is located athttp://privacy.monash.edu/guidelines/collection-personal-information.html#hr
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Flexible Working Arrangements Request Form - Adm.monash.edu.au

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