The purpose of this document is to assist both the supervisor and the employee with a clear
understanding of the employee’s telework arrangement during emergencies. This form does not apply
to telework arrangements made through the disability accommodation process. Each telework checklist
is unique depending on the needs of the position, supervisor, and employee. This form is not
mandatory, nor is it a contract of employment and does not provide any contractual rights to continued
employment. It does not alter or supersede the terms of the existing employment relationship.
Employee Telework (work-at-home)Information:
Employee Name: Banner ID:
Job Title: Department:
Arrangement requested by:
Location where telework(work-at-home) will be performed: Telework (work-at-home) effective dates:
(if end date is known)
The general expectation for a telework (work-at-home)arrangement is that employees will effectively accomplish
their regular job duties, regardless of work location.
While on telework (work-at-home), an employee will:
a. remain accessible during the telework work schedule;
b. check in with the supervisor to discuss status and open issues;
c. be available for teleconferences, scheduled on an as-needed basis;
d. be available to come into the office if a business need arises;
e. request supervisor approval in advance of working any overtime hours (if employee is non-
f. request supervisor approval to use vacation, sick, or other leave in the same manner as
when working at employee’s regular work location.
Employee’s duties, obligations, responsibilities, and conditions of employment with NM Tech remain
unchanged except those obligations and responsibilities specifically addressed in this arrangement. Job
responsibilities, standards of performance, and performance appraisals remain the same as when working
at the normally assigned duty station.
3. The parties acknowledge that this arrangement may be evaluated on an ongoing basis to ensure that
employee’s work quality, efficiency, and productivity are not compromised by the telework arrangement
Specify a date to discuss the effectiveness of the telework arrangement, or enter N/A.
Telework (work-at-home) date:
New Mexico Tech
801 Leroy Place
Socorro, NM 87801
Phone: (575) 835-5206
Fax: (575) 835-5337