SCC TELECOMMUTING FORM
SCC TELECOMMUTING APPROVAL REQUEST
Consu
lt with Human Resources for requests pertaining to an employee’s personal health condition prior to completion of this form.
Do not include employee’s personal health information on this form.
Section I - Employee Information
Employee Name:
Emplo
yee Personal Phone #:
Depart
ment:
Employee ID:
Job Title:
Vice President:
Position Type: Regular Temporary Full-Time Part-Time Position Entry Date:
(start date of current position)
Reason for Request:
Alternate Work Location: Assignment Beginning Date:
Telecommuting Schedule: Assignment Ending Date:
Additional Comments:
Remote Work Plan Details (use additional page if needed):
Statement of Expectations General Guidelines/Conditions
As a condition of working remotely, I understand and acknowledge the following:
• I understand that working from home or other non-traditional work settings imposes additional responsibilities
on me as an employee, as outlined in this document or as my supervisor prescribes.
• I understand that all KCTCS policies will continue to apply to me while I work remotely. I will direct any
questions about the application of a KCTCS policy in a remote work setting to my supervisor.
• I understand my supervisor’s expectations of me while I am in a remote work setting.
• I will adhere to the work schedule and plan provided by my supervisor and all conditions as stated in the SCC
_______________________________ _____________
Employee Signature
_________________________
______ _____________
Supervisor Signature Date
The requested telecommuting schedule is approved not approved .
_______________________________
________________
Vice President Signature and Date
_____________________________________
__________
College President/CEO Signature and Date (if required)
click to sign
signature
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click to sign
signature
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click to sign
signature
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click to sign
signature
click to edit
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