Fillable Telecommuting Request Form/Agreement (Alaska Pacific University)

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Telecommuting Request Form/Agreement (Alaska Pacific University)

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The Telecommuting Request Form/Agreement (Alaska Pacific University) form is 2 pages long and contains:

  • 4 signatures
  • 7 check-boxes
  • 34 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Alaska Pacific University

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Telecommuting Request Form/Agreement
PLEASE READ THIS STATEMENT BEFORE YOU BEGIN THIS REQUEST: By submitting this request, the
employee is attesting they have read the APU Interim Telecommuting Policy, and agrees to abide by its
terms, with the understanding APU may amend the policy from time to time. The employee is also agreeing
to carefully follow the Policy requirements with particular care to the equipment, security and privacy
requirements.
Employee Information
Name:
Department:
Phone Number:
Justification for telecommuting (include why position is a good fit for telecommuting if related to a medical condition do not
list those conditions but provide a healthcare providers note recommending this option to HR)
Physical Address of proposed Alternative Work Location:
This location is: ☐ my home/place of residence Other:
How often will you work from the alternative work location?
☐ Percentage of work time: Schedule:
☐ For the following date range:
Do you access student PII as part of your job?
☐ Yes
☐ No
Do you speak with students or employees as part of your job?
APU devices that will be in use at the alternative work location
☐ Yes
☐ No
Equipment
Any other APU property in use:
Employee Signature: Date:
Street
City
State
Zip Code
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signature
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Supervisor Approval
By approving this request, the supervisor attesting they have read the APU Interim Telecommuting Policy
and allowing the employee to work from an alternative work location is in APU’s best interest. If the
supervisor determines at any point the employee is not abiding by the Interim Telecommuting Policy or
any other APU policy and procedure or is not meeting performance expectations, then the supervisor
must immediately notify their supervisor and HR to allow for re-evaluation of this agreement.
Plan for Supervision (brief plan for managing interfaces, performance, and delivery while employee works from home)
Approval Signatures
Dept. Manager (Print)
Kathleen Wyrick
Signature
Date
Human Resources
Signature
Date
Provost or President
Signature
Date
CC: Personnel File, Payroll Supervisor, Compliance & Risk
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signature
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signature
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signature
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Telecommuting Request FormAgreement (Alaska Pacific University)

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Completed 27 July 2020

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