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Hybrid Work Arrangement Request Form

Authors: Brightmine Editorial Team

When to Use

Use this sample form to permit employees to submit a request for hybrid work arrangements. The form can assist employers that are moving to the hybrid (or blended) workplace model.

This form may not be necessary for organizations that have implemented:

  • All-hybrid workplaces in which an employee has no restrictions on selecting days on which to work at the on-site or remote workplace; or
  • All-remote workplaces.

Below is a model form that should be further tailored to fit the employer's specific needs.