Can this form be signed electronically?

Yes. Electronic signatures are valid in the United States under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure the four-part test of intent, consent, attribution, and retention is satisfied; this HR form is not among the narrow exceptions to e-signature validity.

Do employees need to submit supporting documents?

It depends on the reason. Attach medical documentation or care schedules when relevant, redact unnecessary sensitive details, and follow HIPAA privacy practices if PHI is included; obtain appropriate authorizations and limit PHI in the request itself.

What if the manager denies the request?

Document the denial in writing with reasons and any suggested alternatives. Provide the employee with a written notice, retain the record in personnel files, and allow reconsideration per company policy. Maintain the audit trail for potential disputes or accommodation procedures.

Is notarization or witness required for approvals?

Generally no. Flexible working requests are internal HR records and do not normally require notarization or witnesses. Confirm only if a collective bargaining agreement, employment contract, or specific state law imposes additional authentication requirements.

How long should HR keep completed forms?

Retain completed forms for at least three years after termination for tax and audit purposes per IRC §6501(a), longer if containing PHI under 45 CFR §164.530(j), or if state law or industry rules require extended retention.

Can remote online notarization be used for HR forms?

RON is available in many states for documents that require notarization and involves identity proofing and recorded audio-video. For typical flexible working requests RON is unnecessary; use RON only when a notarized acknowledgement is explicitly required by policy or law.

Electronic Signature
Templates
HR
Flexible Working Request Form

Flexible Working Request Form

This template is fully customizable. Edit the text, fill out the fields, and send it for signature. Give it a try!

Flexible Working Request Form

This form is to be used by employees to request a change to their standard working pattern. Complete all sections as fully as possible. Submission of this request will initiate the employer's review process. Confidentiality will be maintained to the extent practicable, subject to the need to consult managers, HR, and referees where authorized below.

Personal Information

Full legal name Employee ID Home address

Phone

Email

Position Information

Job title

Department

Reporting manager

Date of hire:

Employment status (select all that apply)

Full-time Part-time Temporary/Fixed-term Contract/Consultant

Current standard working pattern

Proposed Flexible Working Arrangement

Type of arrangement requested (select all that apply)

Regular telecommuting/remote work Part-time hours Compressed workweek Staggered start/finish times Job share Other (specify below)

If Other, specify

Proposed start date: Proposed end date (if temporary):

Proposed working pattern and details Impact considerations and cover arrangements

Proposed Weekly Schedule

Monday: Start Finish Location

Tuesday: Start Finish Location

Wednesday: Start Finish Location

Thursday: Start Finish Location

Friday: Start Finish Location

Weekend/Other: Start Finish Location

Employment History

Most recent employer

Dates employed: From To

Primary responsibilities Reason for leaving

Previous employer

Dates employed: From To

Primary responsibilities Reason for leaving

Education

Highest qualification

Graduation/completion date:

Professional References

Reference 1

Reference 2

Reference 3

Legal Disclosures and Authorizations

At-Will Employment: I acknowledge that, unless governed by a written contract that specifies otherwise, my employment is at-will and may be terminated by me or the employer in accordance with applicable policy and law. Approval of this request does not alter the at-will nature of employment or any existing terms and conditions except as expressly modified in writing.

Equal Opportunity: The employer evaluates flexible working requests without unlawful discrimination and will consider reasonable adjustments where required by law.

Authorization to Verify: I authorize the employer to contact my current and former employers, listed referees, and any other parties reasonably necessary to verify information provided in this form and to assess the impact of the proposed arrangement. I also authorize relevant background or security checks if required for my role.

Consent to Data Processing: I understand that information provided on this form will be used for the purpose of evaluating my request and will be retained in accordance with company record-keeping policies and applicable privacy laws.

Consent and authorizations

I consent to the employer contacting the references and previous employers listed above.
I consent to background/security checks where required for my role.

Applicant Certification

I certify that all information provided in this form is true, complete, and accurate to the best of my knowledge. I understand that any misrepresentation may be grounds for disciplinary action up to and including termination. I understand that submission of this form is a request only and does not constitute approval. If approved, terms of any arrangement will be confirmed in writing and may include trial or review periods.

I certify the above statement and agree to cooperate in any reasonable arrangements to implement or review the requested change.

Manager Review (to be completed by manager/HR)

Decision: Approve Deny Approve with modifications

Manager/HR reviewer name

Manager/HR review date:

Manager/HR comments

Employee Printed Name:

Signature:

Date:

What the Flexible Working Request Form is and why it matters

The Flexible Working Request Form is a standardized HR document employees use to propose changes to work arrangements—such as remote work, compressed hours, part-time schedules, or flexible start and end times. It captures employee details, proposed schedule, business justification, duration, and manager review fields. Employers use the form to evaluate operational impact, staffing, eligibility under company policy, and any reasonable accommodation considerations under federal or state law. The form supports consistent decision-making, audit trails, and recordkeeping required for payroll, benefits, and compliance. Use the form with appropriate approvals and retention practices.

Why using a formal request form improves decisions and records

A Flexible Working Request Form standardizes employee proposals, reduces inconsistency in approvals, and documents business rationale for HR and payroll actions. It helps employers assess operational feasibility, record manager decisions for audits, and ensures requests are processed fairly and transparently.

Who completes and reviews a Flexible Working Request Form

Employees and HR teams use the form to propose, review, and document flexible working arrangements across the organization.

Individual employees proposing schedule changes or remote work arrangements for approval
Direct managers or supervisors reviewing operational impact and staffing adjustments
HR or People Operations handling eligibility, records, and formal decision notices

Use role-specific sections to capture necessary approvals, eligibility checks, and any accommodations determined during review.

Essential sections to include on a professional Flexible Working Request Form

A complete form organizes employee data, proposed schedule, business justification, duration, manager review, and HR decision fields for clear, auditable outcomes.

Employee Details

Enter full legal name, job title, department, employee ID, contact information, home work location, and employment status. Accurate details are essential for payroll, tax location, and eligibility checks.

Proposed Schedule

Describe the requested hours, days, remote versus on-site split, start/end times, and any shift rotation. Specify regular or trial period scheduling and any required coverage constraints.

Business Justification

Explain business reasons for the request, impact on productivity, measurable outcomes, collaboration plans, and how responsibilities will be met or delegated during flexible hours, including communication protocols.

Duration

Specify proposed start date, review dates, end date if temporary, and milestone for reassessment. Use MM/DD/YYYY format for every date entered to avoid ambiguity and ensure correct payroll application.

Manager Review

Manager must assess operational fit, staffing needs, potential overtime, and coverage plans. Record approval or denial with date, rationales, and any conditions attached to the arrangement.

HR Decision

HR records final decision, compliance checks (eligibility, benefits impact), notes on accommodation or policy exceptions, effective dates, and retention instructions for personnel file.

Step-by-step: prepare and submit a flexible working request

Follow these steps to prepare, submit, and track a complete request that meets HR policy and manager review needs.

01

Prepare request: Gather employee details, proposed hours, and justification.
02

Complete form: Enter dates in MM/DD/YYYY and attach supporting documents.
03

Submit to manager: Send via HR system or signed email for manager review.
04

Record decision: Manager records approval, conditions, and dates; HR files record.

Set up an online workflow for submitting and approving requests

Set up a repeatable digital workflow to collect requests, route approvals, and store signed records in personnel files.

Form Field and Configuration Options	Configuration setting and help text for each field
Signer authentication and verification method	Email link, SMS code, or KBA as required
Conditional display and validation rules	Show fields when specific roles or answers are selected
Approval routing and escalation paths	Route to manager then HR; set time-based escalations
Storage location and retention policy	Save signed PDF to personnel folder and audit log

Digital signing and technical integration considerations

Use eSignature-capable platforms to collect signatures, verify identity, and retain certified records compatible with payroll and HR systems.

Authentication: Email, SMS, or two-factor
Integrations: Connect to HRIS, payroll, and storage
Document formats: PDF and DOCX supported

Where completed requests go and who acts on them

Describe typical submission paths for a completed request including manager review, HR processing, and final record storage in personnel files.

Submit: Employee submits via HR portal or email to manager
Manager Review: Manager reviews within specified SLA and adds decision
HR Processing: HR verifies eligibility, updates payroll and benefits
Record Storage: Save completed, signed form in personnel file and audit trail

Common deadlines and response time expectations

Typical processing deadlines establish expectations for submission, managerial decision, HR updates, payroll timing, and trial-period reviews.

Minimum submission lead time (staffing):

Typically 14 days before proposed start date

Manager response SLA in business days:

Commonly 5 business days to approve or deny

HR processing time and updates:

One to three business days to update records

Payroll cutoff for schedule changes:

Submit before payroll cutoff to avoid retro pay

Trial period review and reassessment:

Set review at 30 or 60 days depending on role

Key milestones from request to review

Key milestones track submission through decision, implementation, and post-implementation review to ensure clarity and compliance.

01

Submission

Employee files request and attaches supporting documentation

02

Manager Decision

Manager approves, declines, or requests modifications with rationale

03

Implementation

HR updates schedules and notifies payroll and affected teams

04

Review

Conduct reassessment on scheduled review date and record outcomes

Common mistakes to avoid when preparing the form

Submitting incomplete schedules or vague hours that lead to inconsistent approvals and payroll errors and delays
Using informal email agreements instead of the formal form, which prevents consistent records and audit trails
Failing to check eligibility or contractual terms, leading to retroactive pay adjustments or benefit disputes
Not recording manager conditions or expiration dates, causing confusion when temporary arrangements end or remain unreviewed

Risks and potential consequences of incorrect processing

Payroll errors: Incorrect tax withholding

Benefits misalignment: Wrong benefit eligibility

Accommodation liability: ADA claim risk

Recordkeeping violations: Compliance fines possible

Operational gaps: Understaffing or overtime

Data privacy: Personal data exposure

Essential data points captured on the form

Employee Name: Full legal name as on ID

Employee ID: Company-issued employee identification number

Requested Schedule: Days, hours, and remote split

Reason: Business justification and accommodation note

Manager Approval: Manager name, date, and signature

HR Reference: HR case ID and retention category

Real-world examples of how organizations use the form

Sample use cases show how a Flexible Working Request Form appears across roles and industries.

Real Estate example

A property manager used a Flexible Working Request Form to formalize remote and site schedules for leasing agents, ensuring coverage and timely tenant responses across offices.

Reduced scheduling conflicts and clarified payroll.
Tim Martin, Founder of Martin Properties, reported streamlined approvals and fully documented workflows that allowed managers to process requests remotely while preserving compliance and reducing time spent reconciling shift changes and payroll adjustments.

Enterprise operations example

A multinational firm used the form within integrated HR and ERP systems to route requests automatically and update schedules across teams in multiple time zones.

Automated routing reduced manual tracking.
Kodi-Marie Evans, Director of NetSuite Operations at Xerox, described improved flexibility and faster processing when requests triggered NetSuite updates, reducing administrative steps and ensuring consistent records across global teams and compliance checks.

Pricing and feature snapshot for eSignature vendors commonly used with HR forms

Compare core pricing and capability trade-offs for eSignature vendors commonly used to process HR forms like Flexible Working Request Forms.

	signNow	DocuSign	Adobe Sign	PandaDoc	HelloSign
Starting Price	$8/user/mo	$15/user/mo	$14/user/mo	$19/user/mo	$15/user/mo
Free Trial	7-day free trial, no credit card required	Varies by plan	Varies by plan	Varies by plan	Varies by plan
Bulk Send	Yes	Yes	Yes	Yes	No
Audit Trail	Yes	Yes	Yes	Yes	Yes
HIPAA Compliant	Yes	Yes	Yes	No	No

Frequently asked questions about completing and processing the form

Answers to common questions about completing, submitting, and legally validating a Flexible Working Request Form in U.S. workplaces.

Need help? Contact support

Can this form be signed electronically?
Yes. Electronic signatures are valid in the United States under the ESIGN Act (15 U.S.C. ch. 96) and UETA where adopted. Ensure the four-part test of intent, consent, attribution, and retention is satisfied; this HR form is not among the narrow exceptions to e-signature validity.
Do employees need to submit supporting documents?
It depends on the reason. Attach medical documentation or care schedules when relevant, redact unnecessary sensitive details, and follow HIPAA privacy practices if PHI is included; obtain appropriate authorizations and limit PHI in the request itself.
What if the manager denies the request?
Document the denial in writing with reasons and any suggested alternatives. Provide the employee with a written notice, retain the record in personnel files, and allow reconsideration per company policy. Maintain the audit trail for potential disputes or accommodation procedures.
Is notarization or witness required for approvals?
Generally no. Flexible working requests are internal HR records and do not normally require notarization or witnesses. Confirm only if a collective bargaining agreement, employment contract, or specific state law imposes additional authentication requirements.
How long should HR keep completed forms?
Retain completed forms for at least three years after termination for tax and audit purposes per IRC §6501(a), longer if containing PHI under 45 CFR §164.530(j), or if state law or industry rules require extended retention.
Can remote online notarization be used for HR forms?
RON is available in many states for documents that require notarization and involves identity proofing and recorded audio-video. For typical flexible working requests RON is unnecessary; use RON only when a notarized acknowledgement is explicitly required by policy or law.

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