Flexible Work Arrangement Request Form
This document provides guidelines for submitting a Flexible Work Arrangement (FWA) request. It outlines the types of arrangements available and how to properly fill out the request form. Employees looking for flexible work hours or remote work options should refer to this document.
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How do I fill this out?
To fill out the Flexible Work Arrangement Request Form, begin by entering your personal details such as your name and job title. Next, select the type of flexible work arrangement you are requesting and provide the proposed schedule. Finally, ensure you discuss any potential barriers with your supervisor before submission.

How to fill out the Flexible Work Arrangement Request Form?
1
Enter employee details including name and ID.
2
Select the type of Flexible Work Arrangement.
3
Provide the proposed schedule, including start and end dates.
4
Indicate communication expectations with your supervisor.
5
Submit the completed form to your first-level supervisor.
Who needs the Flexible Work Arrangement Request Form?
1
Employees seeking a modified work schedule.
2
Supervisors managing flexible work requests.
3
HR personnel reviewing FWA submissions.
4
Departments requiring remote work arrangements.
5
Students working as interns needing flexible hours.
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What are the instructions for submitting this form?
To submit the Flexible Work Arrangement Request Form, complete all required fields accurately. Send the form via email to your direct supervisor or fax it to the HR department at (XXX) XXX-XXXX. Alternatively, deliver a printed copy directly to your supervisor's office for review.
What are the important dates for this form in 2024 and 2025?
Important dates for submitting FWA requests are typically set at the start of the fiscal year. Ensure that requests for the upcoming year are submitted by established deadlines, usually within the first month of the new calendar year. For individual department deadlines, employees should consult their supervisors.

What is the purpose of this form?
The purpose of the Flexible Work Arrangement Request Form is to facilitate employee requests for modified work conditions. It aims to enhance work-life balance while maintaining productivity and meeting the needs of the organization. By providing a structured approach, it ensures that all requests are documented, reviewed, and approved in a transparent manner.

Tell me about this form and its components and fields line-by-line.

- 1. Employee Name: The full name of the employee submitting the request.
- 2. Emp ID: The unique identification number of the employee.
- 3. Job Title: The current job title of the employee.
- 4. Department: The department where the employee works.
- 5. Flexible Work Arrangement Requested: Details of the type of FWA requested.
- 6. Proposed Schedule: A proposed work schedule including days and hours.
What happens if I fail to submit this form?
Failure to submit this form may lead to delays in accommodating your work arrangement. Furthermore, without proper submission, employees cannot legally work under modified terms. It's essential to follow the process to ensure compliance with workplace regulations.
- Compliance Issues: Not submitting the form can result in non-compliance with HR policies.
- Payroll Processing: Failure to submit may lead to incorrect payroll calculations.
- Lack of Clarity: Not having a submitted request can create confusion regarding work expectations.
How do I know when to use this form?

- 1. Request for Condensed Work Week: Use when seeking a compressed work schedule over fewer days.
- 2. Request for Flexible Time: Utilize this for changing daily start and finish times.
- 3. Request for Remote Work: This is applicable when wishing to work off-campus.
Frequently Asked Questions
What is a Flexible Work Arrangement?
A Flexible Work Arrangement allows employees to adjust their work hours or location to better fit their needs.
How long does an FWA last?
An FWA typically lasts from three to twelve months, depending on approval.
Who approves the FWA request?
The first-level supervisor is responsible for approving FWA requests.
Can I request an FWA for less than three months?
Yes, temporary FWA requests of three months or less can be submitted.
What happens if my FWA is denied?
If denied, you may discuss alternatives with your supervisor.
Do I need to submit this form for temporary remote work?
Yes, even for temporary work, this form should be submitted for approval.
What information do I need to fill out this form?
You need to provide your personal details, proposed schedule, and communication plan.
Can I edit the PDF before submitting?
Absolutely! Use PrintFriendly to edit the PDF as needed.
How do I submit this form?
Submit the completed form to your first-level supervisor for approval.
Is remote work allowed under this FWA?
Yes, flexible workplace options include remote work based on the approval.
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