FORM FW1

FLEXIBLE WORKING APPLICATION FORM

Note to the Employee

You must use this form if you wish to make an application to work flexibly. Before completing this form, you should read the Right to Request Flexible Working Procedure to check you are eligible to make a request. This is available on the intranet.

We will do all we can to process your request as quickly as possible. However, you should be aware that under the timescales laid down in the statutory provisions, it may take up to 14 weeks to consider your request before it can be implemented, and possibly longer where difficulties arise. You should therefore ensure that you submit your application well in advance of the date you wish it to take effect.

It will help your manager to consider your request if you provide as much information as you can about your desired working pattern. You should complete all sections of the form otherwise your application may be deemed invalid. Once complete, pass the application as soon as possible to your manager who will arrange a meeting with you within 28 days to discuss your request.

Your Manager will confirm receipt of your application.

1.Personal Details

Name: / Cluster:
Job Title: / Manager:

I would like to apply to work a flexible working pattern that is different to my current working pattern, under my right provided in law. I confirm I meet the relevant eligibility criteria as follows (please tick which criteria are applicable to this application:

  1. Childcare criterion
  • I have responsibility for the upbringing of a child under 18.
  • I am:

-the mother, father, adopter, guardian or foster parent of the child; or

-married to or the partner of the child’s mother, father, adopter, guardian or foster parent.

  • I am making this request to help me care for the child.
  • I am making this request no later than one day before the child’s 17th birthday (of if the child is disabled, the day before the child’s 18th birthday); or
  1. Adultcare criterion
  • I have responsibility for caring for an adult and am the spouse, partner, civil partner or relative of that adult; or
  • I am not the above but live at the same address as that adult, and
  1. For all applications (ie. under either criterion A or B above)
  • I have worked continuously, as an employee of the Methodist Council, for the last 26 weeks and;
  • I have not made a request to work flexibly under this right during the past 12 months.

2(a)Describe your current working pattern (days/hours/times worked):
2(b) Describe the working pattern you would like to work in future (days/hours/times worked):
2(c) I would like this working pattern to commence from:
3 Please describe how you think this change will affect service delivery, your service
area/colleagues:
4 Please describe how you think the effect on service delivery, your service area/colleagues can be dealt with:
5.Please sign below:
Name:Date:

NOW PASS THIS APPLICATION TO YOUR LINE MANAGER