Flexible Work Arrangement Request

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Arrangement Type

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FLEXIBLE WORK ARRANGEMENT REQUEST

FLEXIBLE WORK ARRANGEMENT REQUEST

Employee: [Employee Name]

Position: [Job Title]

REQUESTED ARRANGEMENT

[Requested Arrangement]

PROPOSED START DATE

[Proposed Start Date]

REASON

[Reason]

APPROVAL

Manager Approval: ______________________

SIGNATURES

Signature

Signature Date

Signature

Signature Date

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