Appendix  A           

Flexible Working Application Form

This form can be used to make a request to work flexibly. Before completing this application, you should read the Flexible Working Guidance the HR Microsite. 

Completed application forms should be forwarded to your line manager and HR – HR@highland.gov.uk .
	
Name:  
	     

	Job Title:

Payroll No:	     

     	
				
Service:
	     

	Name of line manager:	     	
	
Describe your current working pattern (days/hours/times/location worked):

     

     

	
Describe the working pattern you would like to work in future (days/hours/times/location):

     

     

     

	
		
I would like this working pattern to commence from the following date:	     	
	
For homeworking, please declare that you agree to the below terms: 	

 It is the responsibility of each employee to take reasonable care to ensure their own health, safety, and wellbeing; security of equipment and to maintain the working environment to the agreed health and safety standards.

	
Declaration:

 I understand that I can only make 2 applications for Flexible Working in any 12-month period. 

	
	
Signed:	
	Date: