Page 1 of 1
Flexible Hours Request
HR-094
Employee
Employee Name
Employee ID
Schedule
Proposed Start Time
Proposed End Time
Days Affected
Reason
Reason / Details
Decision
Approve
Deny
Needs More Information
Employee Signature
Manager Signature
Date
Confidential · Acme Corporation HR
HR-094 · Flexible Hours Request · Page 1 of 1