Apply to resolve a dispute about flexible working arrangements (Form F10C)

Use this form if: 

• you are an employee entitled to request flexible working arrangements under the National Employment Standards 
• you requested flexible working arrangements because: 
  • you are a parent of a child who is school-age or younger, or are responsible for the  care of a child who is school-age or younger
  • you are a carer
  • you have a disability
  • you are aged 55 or older
  • you are pregnant
  • you are experiencing family and domestic violence, or you provide care or support to a  member of your immediate family or household who is experiencing family or domestic  violence 
• you made your request on or after 6 June 2023 
• your employer has: 
  • refused your request or
  • not responded to your request and it has been more than 21 days since you made the request
• you have tried to resolve the dispute by discussions with your employer
• you want us to help you resolve the dispute. 

This form asks sensitive questions about your personal circumstances. Please read our information on support for your health and wellbeing if you need to. 

We will send a copy of this form and any attachments to your employer. This is so they can understand your side of the case.  

If you are worried about particular information being passed on, don’t include it with your form. Lodge your completed form and then contact us to talk about whether you should provide the information. 

Have this information ready before you begin this form. You will need to tell us: 

• your contact details
• details of a legal representative or paid agent, if you have one
• your employer’s details, including a contact person 
• details of your employment, including when you started working for them
• the reason why you asked for flexible work arrangements 
• the date you made your request
• if your employer responded, details of their response including their reasons for refusing the request
• details about how you have tried to resolve the issue with your employer
• the outcome you want from this application.

You will also need to include: 

• a copy of your written request 
• a copy of your employer’s written response, if they gave you one. 

We store your information in line with the Form F10C privacy notice (pdf).

After we receive your form, we will let your employer know that you have started a dispute case about your request for flexible working arrangements. 

We will send a copy of this form as well as any other documents you have sent us to your employer. This is so your employer can understand your side of the case.  

Your case will then be given to a Commission Member, who will decide how your case will proceed. They might decide to hold a conference or hearing, or they might ask you for more information.

Fair Work Act 2009: Section 65B