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Work From Home Request Form Template

Streamline Your Remote Work Requests with Ease

If you need a seamless way to handle work from home requests, this template is your solution. Designed for managers and HR professionals, it helps you efficiently collect employee information, specific dates, and e-signatures for remote work applications. By using this template, you can reduce administrative time, improve response tracking, and enhance organizational communication while ensuring compliance with company policies. Experience the ease of customizable forms and quick sharing. Try the live template now!

Full name
Work email
Department or team
Manager or supervisor name
Type of remote work requested
One-time work-from-home day
Regular hybrid schedule
Full-time remote
Temporary remote arrangement
Other
Please Specify:
Proposed start date
Requested duration
1 day
1 week
1-3 months
3-6 months
Ongoing/indefinite
Not sure
Days you propose to work from home
Primary reason for this request
Improved focus/productivity
Commute challenges
Health or medical
Caregiving or family
Temporary disruption (e.g., weather, transit)
Relocation or travel
Cost savings
Other
Please Specify:
My core duties can be performed effectively from home
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I have reliable high-speed internet at home
Yes
No
Unsure
I have a dedicated, low-distraction workspace at home
Yes
No
I can protect confidential information in my home workspace
Yes
No
Not applicable
Equipment needed from the company
Access requirements
VPN access
Remote desktop
Cloud storage access
Two-factor authentication token
System permissions update
Collaboration tools (e.g., Teams/Slack)
None
Core hours when you will be reachable (include time zone)
Is on-site presence required for any tasks?
Yes
No
Sometimes
I will follow the companys remote work and IT security policies
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I will maintain a safe home working environment and report incidents
Strongly disagree
Disagree
Neither
Agree
Strongly agree
I understand that performance, working hours, and data privacy expectations remain unchanged while working from home
Strongly disagree
Disagree
Neither
Agree
Strongly agree
Type your full name as your signature
Date
Manager name
Conditions or comments
Date
Decision
Approved
Approved with conditions
Not approved
Needs more information
{"name":"Full name", "url":"https://www.quiz-maker.com/QPREVIEW","txt":"Full name, Work email, Department or team","img":"https://www.quiz-maker.com/3012/images/ogquiz.png"}
Paper art illustration representing a work from home request form for a FormCreatorAI article

When to use this form

Use this form when you need to do your job remotely for a day, a few days, or part of your week. It fits one-off needs like a mild illness, a transit delay, a home repair window, or a short-term caregiving gap, and it also supports planned hybrid schedules. Completing it lets your manager confirm your hours, location, tools, and security steps so coverage and approvals are clear. If you cannot work at all, submit an Absence request form instead. For extended time away to care for a new child, use the Parental leave request form. If you expect extra hours from home to meet a deadline, pair this with the Overtime request form. You get faster decisions and fewer back-and-forth emails.

Must Ask Work From Home Request Questions

  1. What date(s) and time(s) are you requesting to work remotely?

    Specific start and end times help managers plan coverage and approvals. Clear windows also prevent conflicts with on-site schedules and team handoffs.

  2. What is the reason for your remote work request?

    A brief reason (illness, transportation, caregiving, focus work, weather) guides priority and policy fit. It also helps HR spot trends and offer the right support.

  3. Where will you work from, and is the space secure and distraction-free?

    Your work location and environment affect data security, compliance, and safety planning. If your request relates to faith observance needs, HR may direct you to the Religious accommodation request form.

  4. What tasks and meetings will you complete, and how will you stay reachable?

    Listing deliverables and meeting plans sets clear expectations. Contact methods (chat, phone, video) keep your team aligned during the day.

  5. Do you need equipment, system access, or manager approvals to work off-site?

    Capturing tools and access early prevents delays on the day you work remotely. It also flags any costs or overtime considerations for rapid sign-off.

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