Fillable Request for Temporary Telecommuting Arrangement During Response Period (Kean College)

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Request for Temporary Telecommuting Arrangement During Response Period (Kean College)

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Request for Temporary Telecommuting Arrangement
During Response Period for COVID-19
Please complete this request form and submit to the Office of Human Resources. You must submit
the appropriate medical certification or documentation verifying school closing within five business
days. If you have questions, please contact the Office of Human Resources at (908) 737-3300 or via
email at benefits@kean.edu.
Name: Title:
Home Address:
Home Telephone: Work Extension:
Email:
Requested Accommodation Period: July/August Fall 2020
I hereby request a temporary telecommuting arrangement during our response period for
COVID-19, due to the following reasons:
I am at higher risk for getting very sick from COVID-19 as identified by CDC guidelines. !
Examples include older adults and people who have serious chronic medical conditions.
I need to stay home with a child due to the coronavirus-related closure of a preschool !
program, childcare program, elementary or secondary school.
I need to request a partial accommodation to stay home with a child due to the coronavirus‐!
related closure of a preschool program, childcare program, elementary or secondary school
•
The current period of COVID-19 response is limited to July/August and Fall Semesters.
If there is no change to the environment and Kean University extends the timeframe for
the COVID-19 response, any approved temporary telecommuting arrangements in place at
that time will also automatically extend.
•
I understand that during normal business operations, the essential functions of positions at
Kean University require physical presence on campus.
•
I acknowledge that I have informed my supervisor of my request for a temporary
telecommuting arrangement.
Employee Signature
Date
I acknowledge that I have been made aware of this employee’s request for temporary
telecommuting arrangement.
Signature of Supervisor/Chairperson/Executive Director
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Request for Temporary Telecommuting Arrangement During Response Period (Kean College)

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Completed 23 July 2020

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