EXAMPLE 1: Sample Agreement Between Agency and Employee Approved for Telecommuting on a Continuing Basis
The supervisor and the employee should each keep a copy of this agreement for reference.
Salary and Benefits
Duty Station and Alternative Workplace
Note: All pay, leave and travel entitlements are based on the official duty station.
Work Schedule and Tour of Duty
Time and Attendance
(Employee's Signature and Date)_____________________________________________
(Supervisor's Signature and Date)_____________________________________________
EXAMPLE 2: Telecomuting (Flexiplace) Pilot Program Work Agreement
Type of Telecommuting (Flexiplace) Request: Medical ___ Non-Medical ___
The following constitutes an agreement between:
Employee's Name (print) ______________________________________
1. Employee agrees to participate in this program on a voluntary basis and to adhere to the applicable guidelines and policies.
2. The agreement is made for a specified period of time not to exceed 6 months. The employee may work at the alternate duty station a maximum of 1 day per week during the agreement period. Employee agrees to participate in this program for the period of time:
and ending: (month/day/year) _______________________
3. Employee's official duty station is:
4. Employee is allowed to participate in any type of work schedule authorized for use by his/her immediate organization. Normal rules and procedures apply for authorizing, approving, earning, and using of leave, overtime, credit hours, compensatory time, etc. Failure to obtain prior approval for overtime work or earning of credit hours may result in the employee's removal from the flexiplace program or other appropriate action.
Management reserves the right to alter the employee's established work schedule to accommodate work demands or for any other official purpose.
5. Employee's time and attendance will be recorded as performing official duties at the official duty station. The normal duty day must be accounted for by hours worked, some form of authorized leave, or any combination thereof. All leave and travel entitlement will be based on the employee's official duty station.
6. Employee will meet the supervisor or others as necessary, appropriate, or requested in order to perform assigned duties or to fulfill organizational requirements. This includes such activities as attending required training programs, receiving assignments, reviewing completed work, attending meetings, providing progress reports etc.
7. If the employee requires Government property at the alternate duty station, the employee may request a loan of such items. The loan, use, security, and protection of Government property must be in accordance with established policies and procedures. The employee is responsible for immediately notifying his/her supervisor if Government-owned property fails to operate properly or is damaged. Employee-owned property, computer equipment, software, etc. is the sole responsibility of the employee.
Government-owned computer equipment and software will be serviced and maintained by the Government at a location of its choosing. The employee agrees to follow the terms of computer software license and copyright agreements, as well as computer virus and protecti The agreement may be renewed or extended at the end of the originally agreed upon period.
Supevisor's Signature: ____________________________________ Date:_________
EXAMPLE 3. FLEXIPLACE TEST: APPLICATION FORM
If you fail to return this form by the requested date, we will assume that you do not wish to participate in the Telecommuting Program. If you choose not to participate in this program, you will continue to work at your official workstation.
1. Mark your choice:
I wish to work at a satellite facility (Telecommuting Center). ____
2. Place the number "1" next to the day you would most like to work at home as your first choice. Next, place the number "2" next to the day you would like to work at home as your second choice.
3. Place the number "1" next to the day you would most like to work at the satellite facility or telecommuting center as your first choice. Next, place the number "2" next to the day you would like to work at the satellite facility or telecommuting center as your second choice.
4. For your information only, attached is a list of available satellite facilities or telecommuting centers. Select the one that you are most interested in and list it here. DO NOT contact the center yourself.
For more information contact Dr. Wendell Joice on (202) 273-4664 or email at email@example.com