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Letter to Request Flexible Working - Template Form

✓ Valid in United Kingdom

Create your Letter to Request Flexible Working - Template Form for use in United Kingdom. Answer a few plain-English questions and the document fills in automatically as you go — then download it in Word and PDF, ready to sign or share.

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Letter to Request Flexible Working - Template Form
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Dear Sir/Madam,

RE: Flexible Working Request

I write to make a request for flexible working. My request is sent in exercise of my contractual right under section 33 of the NHS terms and conditions of service.

You will be aware that I have been continuously employed by ________ since ________ as a ________.

My current working arrangements are as follows:

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My request is that my terms and conditions of employment be altered so as to change my hours of work to the following:

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I would like this change to take effect on ________.

My request relates to the risk posed by the ongoing COVID-19 pandemic. I am particularly concerned about:

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I am recognised as a vulnerable person in terms of the risk posed by COVID-19 in view of the following condition: ________.

I wish to advise you that I have a disability, namely: ________. As a result of that disability, I currently suffer from the following disadvantages:

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I believe the requested changes to my terms and conditions of employment would have the following beneficial effects on ________:

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I appreciate that the requested changes to my terms and conditions of employment may also give rise to the following issues for ________:

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However, these issues could easily be addressed.

Your sincerely,



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Fields you complete are inserted into the document live. This template is general guidance only — not legal advice.