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Hybrid Work Request Form




Name _________________ Job Title _____________________

Department ________________ Reporting Manager __________________

Number of days I would like to telecommute in a week: __________________

Remote work location: ­­­­­­­­­­­­________________

Reason for the Hybrid work request:

HYBRID WORK APPLICANT

I'm asking for permission to work a hybrid schedule that includes working remotely, as specified in this form. I have discussed hybrid working with my supervisor and understand that my application does not guarantee that I will be eligible for hybrid working. I'm willing to return to the workplace whenever my manager thinks it's appropriate. I have read, understood, and concur to abide by the company's remote work regulations and policies. I am aware that the right to perform remote work may be revoked at any time by [Company Name]. Signing here confirms that I accept these terms and conditions.

Hybrid Work Applicants Signature ___________________
Date __________________

REPORTING MANAGER

I have discussed the possibility of hybrid working with [Employee’s Name] for ________ days in a week. I approve __________ / disapprove ___________ [Employee’s Name] for hybrid working.

Supervisors Signature________________ Date ________________

HUMAN RESOURCES

Approval ___________ Disapproval ___________


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