Flexible Work Arrangement Request Form

Employee Name*
Supervisor's Name

STAFF MEMBER ACKNOWLEDGEMENT

I have read and understand the Flexible Work Arrangement Policy, found in the Employee Handbook, and agree to the terms of this arrangement. I understand it is my responsibility to make my flexible work arrangement a success and that Union has the right to discontinue this arrangement at any time.

Date*

SUPERVISOR EVALUATION AND RESPONSE

Before approving or denying this request, supervisors must seek approval from their Vice President and consult with the Chief Human Resources Officer or their designee. This is necessary to ensure these requests are evaluated consistently and equitably across departments and positions.


APPROVED OR DENIED:*
Date*