Flexible Working Decision Appeal Form (Staff under SNCT Teachers Conditions only)

1.	Please complete this form if your Headteacher/Manager has declined your request to work flexibly and you wish to appeal against their decision.  
2.	You must complete the form within 14 days of receipt of the decision from your Headteacher/ Manager declining your flexible working application. 
3.	Please send a copy of the completed form to the manager of your Headteacher/Manager or the next level of management within the Service.
4.	On receipt of the form, you will be invited to an appeal hearing which will normally be conducted by the line manager of your Headteacher/Manager who rejected your request to work flexibly.
5.	Further information on the appeal process can be found in  LNCT 38 - Flexible Working Policy

Name:	     	
Job title:	     	
School/Department:	     	
Name of your Headteacher/Manager who rejected your flexible working application:	     	
Date of flexible working meeting:	     	
Date you received the decision:	     	
Name of your work colleague, union representative or support worker who will accompany you to the appeal: 	     	
Please state the grounds of your appeal (e.g. procedural, new information not raised at the Flexible Working Meeting or a challenge to the facts in the reasons your Headteacher/Manager gave when rejecting your request):	     	
Signature: 	Date:      	
Receipt of this form must be acknowledged