<p>[EMPLOYER'S NAME] [ADDRESS LINE 1] [ADDRESS LINE 2] [POSTCODE]</p><p>[DATE]</p><p>Dear [MANAGER],</p><p>Flexible working request </p><p>I would like to apply to work a flexible working pattern under [[NAME OF EMPLOYER]'s flexible working procedure and] my statutory right to request flexible working. </p><p>ELIGIBILITY TO MAKE A REQUEST I confirm that I am eligible to make a flexible working request because:</p><p>· I have been employed by [NAME OF EMPLOYER] for the last 26 weeks. I have worked in [NAME OF DEPARTMENT] as [JOB TITLE] since [DATE] [and my employee reference number is [REFERENCE NUMBER]].</p><p>· I have not exercised my statutory right to request flexible working during the past 12 months. [I did, however, [DETAILS OF ANY OTHER FORMAL OR INFORMAL REQUESTS TO WORK FLEXIBLY OR CHANGE WORKING HOURS].]</p><p>MY CURRENT WORKING PATTERN [INCLUDE DETAILS OF EMPLOYEE'S CURRENT WORKING PATTERN, INCLUDING PLACE, DAYS, HOURS AND TIMES OF WORK. INCLUDE DETAILS OF ANY RELEVANT EMPLOYMENT HISTORY]</p><p>MY PROPOSED WORKING PATTERN I need to work flexibly to [PROVIDE INFORMATION ABOUT THE REASONS FOR THE REQUEST] and propose the following changes: [INCLUDE DETAILS OF EMPLOYEE'S PROPOSED NEW PATTERN OF WORK INCLUDING PLACE, DAYS, HOURS AND TIMES OF WORK, TOGETHER WITH PROPOSED DATE ON WHICH THE VARIATION WOULD TAKE EFFECT].</p><p>IMPACT AND SUGGESTED ACCOMMODATION OF NEW WORKING PATTERN I think this change in my working pattern will affect [NAME OF EMPLOYER] and my colleagues as follows: [INCLUDE DETAILS OF POTENTIAL IMPACT OF THE CHANGE ON EMPLOYEE'S IMMEDIATE COLLEAGUES, DEPARTMENT, AND THE</p><p>1 EMPLOYER'S WIDER BUSINESS, CLIENTS AND CUSTOMERS WHERE RELEVANT TO THE JOB IN QUESTION].</p><p>I think the effect on [NAME OF EMPLOYER] and my colleagues can be dealt with as follows: [INCLUDE DETAILS OF ANY SUGGESTIONS AS TO HOW TO DEAL WITH THE POTENTIAL IMPACT OF THE CHANGE IDENTIFIED ABOVE]. </p><p>I look forward to hearing from you. </p><p>Yours sincerely,</p><p>...... [EMPLOYEE]</p><p>2</p>