Standard Individual Telework Agreement Form - U.s. Department Of Labor printable pdf download

Standard Individual Telework Agreement Form - U.s. Department Of Labor

U.S. DEPARTMENT OF LABOR

Section 15: Standard Individual Telework Agreement

The following constitutes an agreement between the named employee and the Agency on the terms and conditions

of the individual's participation in the DOL Telework Program.

Employee Name: _____________________________________________________________________

Agency:_____________________________________________________________________________

Official Duty Station Address:___________________________________________________________

Alternate Worksite Address: ____________________________________________________________

Business Telephone:___________________________________________________________________

Email Address: _______________________________________________________________________

Fax Number: _________________________________________________________________________

Supervisor Name:______________________________________________________________________

This agreement is for a formal arrangement. The employee will telework under a formal arrangement on

the days identified below in a bi-weekly pay period. Nothing precludes the employee and supervisor from

informally agreeing that the employee will report to the office on a scheduled telework day on an ad hoc/as

needed basis.

Telework Schedule

Week 1:

Week 2:

□ Monday

□ Tuesday

□ Wednesday

□ Thursday

□ Friday

This agreement is for an informal arrangement. The employee will telework on an ad hoc/as needed basis

with supervisory approval.

The employee's telework arrangement will begin on

The employee chooses

chooses not

to participate in the office's flexitime work schedule (must select one)

If the employee chooses not to participate in the office’s flexitime work schedule, the employee and supervisor

agree that the employee's official tour of duty will be from

If the employee chooses to participate in the office's flexitime work schedule, the employee will communicate

his/her daily start and stop times by means of

Everything in this Section is subject to office coverage needs as outlined in Article 12 and Article 5 of the DOL -

Local 12 Collective Bargaining Agreement.

The rules and policies governing the employee's time & attendance, and the requesting of overtime and leave are

unchanged by participation in the telework program. Employees must obtain supervisory approval before taking

leave in accordance with prescribed office procedures and applicable law, rule, or regulation. If the employee works

overtime that has been directed and/or approved in advance, the employee will be compensated in accordance with

applicable law, rule, or regulation.

Standard Individual Telework Agreement Form - U.s. Department Of Labor