Date:

Applicant:

Tel.:

Dept. / Institution / Org. Unit:HR Department Domstraße 14 17489 Greifswald

Signature

approved

Date

part-time work) with

Initial request for a reduction in working hours (switch to part-time work)

permanently

for a temporary period until

hours/week

Reason: e.g. caring for a child, supporting a family member with care needs / desired distribution of working hours

not approved

(specify date on which you want to beginnI wish to apply for part-time work as of

Dear Sir/Madam,

Request for Part-Time Work

Written Statement from Applicant's Supervisor / Line Manager The weekly work schedule requested by the applicant is

Continuation of part-time working status

Reason for superviso's/line manager's decision

Date Signatore

subject to approval

The English translation of this form is intended solely as a convenience to non-German-reading members of the University. You may use the form in the English version, however, only the text of the German form is legally binding. In the event of any conflict between the English and German text, its structure, meaning or interpretation, the German text, its structure, meaning or interpretation shall prevail.