Flexible Work Schedule Approval Form
Please fill out this form to request approval for a flexible work schedule.
Employee Full Name
First Name
Last Name
Employee ID
Department
Please Select
Human Resources
Finance
Marketing
Sales
IT
Operations
Customer Service
Email Address
example@example.com
Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Requested Flexible Work Schedule Start Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requested Flexible Work Schedule End Date
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Reason for Requesting Flexible Work Schedule
Preferred Work Hours
6 AM - 2 PM
8 AM - 4 PM
10 AM - 6 PM
12 PM - 8 PM
Other (please specify)
If 'Other', please specify your preferred work hours
Manager's Comments
Manager's Approval
Approved
Denied
Pending
Submit
Should be Empty: