Flexible work request form

Request a different schedule, compressed week, part-time hours or remote days, with a plan for coverage.

Use it on screen
Flexible work request formCurrentRequestedImpactDecision🕰️
How to use itThe employee describes the arrangement and how work will be covered. The manager decides within a set time, often with a trial period.

Who it is for and when to use it

Flexible arrangements, such as compressed weeks or later start times, can keep valued employees. A written request makes the discussion concrete.

Requests linked to disability, pregnancy or religion may require you to consider accommodation. Treat those under the right process.

12 items. Fill it in on screen or print a copy.

Current

Requested

Impact

Decision

How to use the flexible work request form step by step

  1. Consider each request on its merits.
  2. Use trial periods.
  3. Explain declines.
  4. Update the schedule.
  5. Review after the trial.

A flexible work request form in use

A warehouse lead asks to work four 10-hour days instead of five 8-hour days. The manager approves a six-week trial, checks coverage on Fridays and makes it permanent.

Why it matters

A written request and decision let you treat similar requests consistently and show what was weighed, which helps if a refusal is questioned. A few places, such as San Francisco and Vermont, give some workers a legal right to request flexible schedules and receive a response, so recording the date and reason is good practice anywhere.

Filled-in sample

Role Accounts payable clerk
Current schedule Monday to Friday, 8:00 am to 4:30 pm
Type requested Different hours
Proposed schedule Monday to Friday, 9:30 am to 6:00 pm
Reason given School drop-off
Coverage plan Vendor calls before 9:30 go to Lin
Decision Approved, 8-week trial, review November 18

Sample for Coastal Supply Co. in Charleston, South Carolina. A later start keeps the same eight working hours a day, so the only real question was early coverage, which the named backup answers.

Common mistakes to avoid

Adapt it to your team

Healthcare and care homesApprove flex only within staffing ratios and require a swap partner for any fixed shift change.
Office and admin teamsUse core hours, such as 10 to 3, and let the start and end times float around them.
From the fieldSuggest that the employee propose two options instead of one. It turns a yes or no into a conversation about what works for both sides.

Questions about the flexible work request form

Must I approve requests?

Usually not, unless an accommodation or law applies.

What about overtime on 10-hour days?

Federal overtime is weekly, but some states have daily overtime.

Should there be a trial?

Yes, it lowers the risk.

Can it be reversed?

Set that in the decision.

Can an exempt employee request a compressed workweek?

Yes, and it is simpler than for hourly staff, since exempt employees are paid a salary however their hours fall across the week. The form should still list the day off and who handles urgent work on that day.

Can switching to part-time hours affect benefits?

It can, because many health and retirement plans set an hours threshold, such as 30 hours a week. Check the plan rules before approving fewer hours and write any benefits change on the form so the employee agrees knowing the effect.

Related resources

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Know who worked when

Use the flexible work request form for the record you need today. To see who clocked in, and when, book a demo of EZTime.

Disclaimer: This template is general information, not legal advice. Employment rules differ by state and city and change over time. Have a qualified employment attorney or HR professional review it before you use it.