EMPLOYEE TELEWORK APPLICATION PACKET

EMPLOYEE TELEWORK APPLICATION PACKET

Inside:

Employee Application Instructions: Procedures for Requesting Telework

Employee Application Form 1: Request to Participate in the Telework Program

Employee Application Form 2: Employee's Assessment for Telework Suitability

PROCEDURES FOR REQUESTING TELEWORK

Employee Application Instructions

Employee's Responsibility

Eligible employees requesting to work a Telework schedule must:

1. Review the information in this form. 2. Complete the Request to Telework form. 3. Complete the Self-Assessment for Telework Suitability form including specifying the requested Telework

work hours. Specify the requested fixed day(s) teleworking. 4. Sign/date both forms and forward to their Supervisor for review.

Supervisor's Responsibility

The supervisor must evaluate and recommend approval/denial of the Employee's request to work a Telework schedule using the following criterion:

1. Operational requirements must be met. 2. The implementation of the proposed work schedule must not adversely affect or diminish the Department's

ability to provide services during normal business hours. 3. The implementation of a Telework schedule must be cost-neutral to the Department. 4. The Department must establish the work hours and work days predicated on the criteria documented above.

The Supervisor must review the employee's forms, complete the Manager/Supervisor Assessment of Employee's Suitability for Telework form and meet with the Employee to discuss the request. The Supervisor must then either:

1. Recommend approval to the Department Director or his/her designee. 2. Recommend denial to the Department Director or his/her designee. 3. Suggest modifications for consideration by the employee. 4. Submit their recommendation to the Department Director or his/her designee for review.

Department Director's Responsibility

The decision of the Department Director is final. The Department Director must review the work schedule recommendation and either:

1. Approve the request; 2. Deny the request; or 3. Suggest modifications for consideration by the supervisor/employee.

The Department must then: 1. Give a copy of the approved or denied request to the employee. If the request is not approved, the employee must be informed of the reason for denial. 2. Ensure a copy of the request and supporting documentation is placed in the Department's Telework Coordinator operating file. 3. Send a copy of the OHR Telework Coordinator to telework@.

If the request is approved, the employee must complete training and the Telework Agreement before starting to Telework.

4/3/2017

REQUEST TO PARTICIPATE IN THE TELEWORK PROGRAM

Employee Application Form 1

Employees interested in Telework must complete this form along with the "Assessment for Telework Suitability" form and present both documents to their supervisor for review.

Employee's Name: _____________________________Job Title: _________________________

Department/Division/Section: _________________________Supervisor: __________________

Number of days I would like to Telework: Per week ____________ Per month ______________

Please describe how you think your job responsibilities are suited for Teleworking: _(5_2_0__C_h_a_r_a_c_t_e_r _M_a_x__im__u_m__.)________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

_______________________________________________________________________________

Employee: I have discussed Teleworking with my supervisor and understand that this request does not constitute a formal application/agreement or guarantee that I will be approved to Telework. I have read the Telework Program Policy and Procedures and understand that Teleworking is not an entitlement and that it may not be appropriate for every employee to Telework.

_____________________________________ Employee's Signature

____________________________________ Date

Supervisor: I have discussed the possibility of Teleworking with the above-named employee. We have completed the Assessment for Telework Suitability. Based on the Assessment and the job responsibilities and performance in his or her current position I believe this employee

____ is _____is not

a candidate for Teleworking and I have informed the employee of the outcome of this process.

______________________________________ Supervisor's Signature

______________________________ Date

4/3/2017

EMPLOYEE'S ASSESSMENT FOR TELEWORK SUITABILITY

Employee Application Form 2

Employee's Name: ___________________________________ Department/Division: __________________________________

Job Title: __________________________ Location: __________________________

Self-Assessment of Your Position

Job Criteria

Work is information based.

Your Position Profile Please comment on the match between the criteria to the left and this position. (100 Character Maximum)

Minimal unpredictable face-to-face contact is required.

The Teleworker works alone on assignments, such as data entry, report or proposal writing, research, or analysis.

Productivity can be monitored/measured easily.

Other factors to consider:

Teleworker Criteria

Completed probationary period and achieved merit status.

Your Profile Please comment on the match between the criteria to the left and this employee.

Successful "meets expectations" performance evaluation.

Self-directed (demonstrated ability to manage own time and work).

Demonstrated ability to solve own problems; low need for assistance from supervisor or others.

Low need for daily interaction with coworkers.

The proposed Telework Remote Work Location is free from distractions (children or others in need of care, etc.).

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Proposed Telework Schedule Monday Tuesday Wednesday Thursday Friday Saturday Sunday

Hours*

Meal Period

Location** * Work hours must include a ? hour unpaid meal period.

**For location, please use "R" for Remote Work Location and "M" for Main Worksite.

The Teleworker should have regularly scheduled days/hours at the Main Worksite so others will know when he/she is available for meetings. Remote Work Location:

Address: ___________________________________________________________ ___________________________________________________________

Phone: __________________________Fax: _____________________________ Email Address: ______________________________________________________

Date Given to Supervisor: ______________________

Reviewed: _____________________________________ Manager/Supervisor's Signature

______________________________________ Department Director's Signature

_____________________________________ Department Telework Coordinator's Signature

________________________ Date

________________________ Date

________________________ Date

4/3/2017

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