Official form guide
This template guides employees in formally requesting changes to their standard work schedule or location. It is used when an employee wishes to discuss and formalize a flexible working arrangement with their employer.
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Form Overview
This template guides employees in formally requesting changes to their standard work schedule or location. It is used when an employee wishes to discuss and formalize a flexible working arrangement with their employer.
Plain English
If you want to adjust your usual hours, start working from home sometimes, or change your roster, this form helps structure that request. It provides a clear way to propose changes to your current work setup within Australian workplace law.
Submission Date
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Need to report workplace harassment
The process differs from a work arrangement request.
✓ Check internal company policy first.
Disputing pay or hours worked
Pay disputes must follow specific statutory procedures, not this template.
✓ Verify the correct dispute channel.
Fair Work Commission online portal (or relevant payslip dispute system)
Reporting an industrial injury at work
Injuries require immediate safety reporting, separate from scheduling changes.
✓ Contact your supervisor or WHS officer immediately.
Workplace Health and Safety reporting form (e.g., WorkCover NSW/VIC)
There are no fixed deadlines specified for making or accepting flexible work requests.
Field map
Applicant
1 items
Full name (and representative, if any), postal address, email, and phone number of the person or organisation lodging the application.
Respondent
1 items
The exact legal name and ABN of the employer or other party the application is made against.
The Matter
2 items
Identify the kind of matter — for example, unfair dismissal, general protections, or an agreement application.
A clear description of what happened, relevant dates, and the outcome you are seeking.
Dates
1 items
Relevant dates such as the date of dismissal or the date the issue arose — these determine whether you are within time.
Supporting
1 items
Any documents that support your application, such as letters, contracts, or notices.
Declaration
1 items
Sign and date the form. Applications may also require a fee or an application for a fee waiver.
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Fillable formOpen in Editor->This template is a guide for employees to initiate discussions with their employer regarding flexible work. Use it to formally document your request for changing your standard working hours or location.
Quick Facts
Mistaking this template for a legal right; it initiates a discussion, but approval must be negotiated.
Assuming that submitting the form automatically triggers an immediate response from HR.
Failing to understand that 'flexible' arrangements must still meet core job requirements and company needs.
Not understanding the difference between requesting flexibility (this form) and reporting mandatory workplace rights issues.
Source transparency
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