Letter to Request Flexible Working - Template Form

EMPLOYEE REQUEST FOR FLEXTIME WORK SCHEDULE

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Re: Request for Flextime Work Schedule — ________

Dear ________:

I am writing to formally request an adjustment to my current work schedule to a flexible work arrangement (edescribed below. I have been employed by ________ as ________ since ________, and I greatly value the opportunity to contribute to the organization. I respectfully submit this request for your consideration.

I believe a flextime schedule, which adjusts my daily start and end times while maintaining my full complement of scheduled work hours, would benefit both the Company and me without diminishing the quality, availability, or volume of my work.

§ 1. Reason for the Request. The basis for my request is as follows: ________. To the extent this request relates to a disability, a serious health condition, or another circumstance protected by law, I am willing to engage in an interactive process and to provide any documentation reasonably required to support an accommodation under applicable federal and state law.

§ 2. Proposed Schedule. My proposed flextime schedule would be as follows:

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The proposed schedule would total ________ hours per week and would take effect on ________.

§ 3. Core Hours and Availability. To ensure consistent coverage and collaboration, I propose the following designated core hours during which I will be present and reachable: ________. I will remain available for meetings, telephone calls, and time-sensitive matters as set forth above and will respond to communications promptly during all scheduled work hours. My primary work location under this arrangement would be ________.

§ 4. Benefits to the Company. A flextime arrangement may enhance productivity, support the recruitment and retention of qualified personnel, reduce costs associated with turnover and training, and allow work to be performed during periods of peak individual productivity, all without altering my responsibilities, performance standards, or duties to the Company.

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§ 6. Wage and Hour Compliance. I understand that any approved schedule must comply with the Fair Labor Standards Act (29 U.S.C. § 201 et seq.) and applicable state wage-and-hour laws, including any requirements governing meal and rest periods, recordkeeping, and overtime, and that the Company will continue to record and compensate all hours worked as required by law. ________

§ 7. Trial Period and Review. I propose that this arrangement be implemented on a trial basis for a period of ________, after which the Company and I may meet to review its effectiveness. I acknowledge that the Company retains sole discretion to approve, modify, suspend, or discontinue any flextime arrangement based on operational needs, performance, or other legitimate business reasons, subject to applicable law.

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Thank you very much for your consideration.

Sincerely,

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Date: ________

FOR COMPANY USE ONLY

This request is hereby:   [   ] Approved    [   ] Approved as Modified    [   ] Denied

Conditions / Modifications (if any): ________

Approved Effective Date: ________

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