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DEPARTMENT OF ADMINISTRATION (Rhode Island College)

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  • 12 other fields

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File type: PDF

U.S.A. forms for Rhode Island College

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STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF ADMINISTRATION
Division of Human Resources
Teleworking Agreement
Created 06/28/18 **Employees are selected to participate at the sole discretion of management** Page 1 of 2
Employee Name:
Employee Job Title:
I ______________________________ attest that I have reviewed the current Department of Administration’s
Teleworking Policy and agree to comply with the terms and conditions in said policy in addition to the following:
▪ I agree to spend approved Telework time performing the assigned duties and responsibilities of my position
▪ I agree to maintain contact with my work unit, as appropriate, to successfully perform my assigned duties and
responsibilities
▪ I agree to maintain a safe work environment that is conducive to productivity
▪ I have made arrangements, if applicable, for dependent care, and personal disruptions such as non-business
telephone calls and visitors will be kept to a minimum
▪ I understand that this telework arrangement is a privilege and is not an employee right
▪ I understand that the State is not liable for any damages to my personal or real property while I am performing
official duties at my alternate work location
▪ I understand that I must immediately report to my manager or supervisor any work-related injuries that occur
while in the Telework arrangement
▪ I understand this arrangement shall not be the basis for any claim regarding overtime, mileage, or any benefit
that would not be provided at the regular workstation. My salary, job responsibilities, benefits, rights, and
insurance coverage will remain the same as the applicable bargaining unit contract
▪ I understand that this arrangement is effective from (enter dates: mm/dd/yy) _________ to _________, and that
it can be modified, amended, or terminated at any time by written notification from the agency head or
designee, with or without cause
▪ I understand that should a performance issue arise, my participation in this program shall be terminated and I
will return to my official workstation in the State Offices
▪ Additional conditions agreed to by the telecommuting employee and management:
I understand and have received the Department of Administration’s Teleworking Policy and agree to comply with all
the agencies policies and procedures.
Employee Signature
Date
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signature
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STATE OF RHODE ISLAND AND PROVIDENCE PLANTATIONS
DEPARTMENT OF ADMINISTRATION
Division of Human Resources
Teleworking Agreement
Created 06/28/18 **Employees are selected to participate at the sole discretion of management** Page 2 of 2
Employee Name:
Employee Job Title:
To be completed by Director
I reviewed the request and the employee eligibility criteria and the needs of the organization. Based on this review,
I have determined that the Telework Arrangement should be ☐ Approved ☐ Denied
Manger/Supervisor Signature
Date
Division Director Signature
Date
Executive Director of Human Resources/Personnel Administrator Signature
Date
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signature
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signature
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signature
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DEPARTMENT OF ADMINISTRATION (Rhode Island College)

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Completed 23 July 2020

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