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Appendices
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Telework Appendices
TELEWORK APPLICATION AND AGREEMENT
Section I (To be completed by the employee)
Employee’s Name: Organization: Telephone:
Supervisor’s Name and Title: Telephone:
Address and Description of Alternate Work site: Telephone:
Description of work to be performed at the Alternate Workplace:
Equipment needed to perform work at the alternate workplace:
Furnished by the Employee Furnished by the Agency
Telework Schedule and Tour of Duty: ( )
Regularly Scheduled ( )
Intermittent Work Schedule Hours:
AWS Day Off (if applicable):
Telework Days:
Voluntary Participation
The applicant voluntarily agrees to work at the approved alternate workplace indicated above and to follow all applicable policies and procedures. The applicant recognizes that the telework arrangement is a privilege, not a right.
Salary and Benefits
The supervisor and applicant agree that a telework arrangement is not a basis for changing the applicant’s salary or benefits.
Official Duties
The applicant agrees not to conduct personal business while in an official duty status at the alternate work place (for example, caring for dependents or making home repairs). Furthermore, the applicant agrees that telework is not a substitute for childcare, and that he or she will make appropriate arrangements for childcare as necessary to provide for a minimum of interruptions during the workday.
Time and Attendance
The supervisor agrees to certify bi-weekly the time and attendance for hours worked at the regular office and the alternate workplace and to make sure that the applicant’s timekeeper has a copy of the applicant’s work schedule. The employee will be required to complete a time and attendance worksheet to document hours worked.
Leave
The applicant agrees to follow established office procedures for requesting and obtaining approval for leave.
Overtime
The applicant agrees to work overtime only when approved in writing and in advance by the supervisor, and understands that claimed overtime work without such approval may result in termination of the telework privilege.
Alternate Workplace Costs
The employee understands that the Government will not be responsible for any operating costs that are associated with the use of the employee’s home as an alternate work site, for example, home maintenance, insurance or utilities. The employee also understands that any entitlement to reimbursement for authorized expenses incurred while conducting business for the Government, as provided for by statute or regulation, is not relinquished by this agreement.
Equipment/Supplies
The employee agrees to protect any government-owned equipment and to use the equipment only for official purposes. The agency agrees to issue, service and maintain any government-owned equipment issued to the employee. The employee agrees to service, and maintain any personal equipment used. The agency agrees to provide the employee with all necessary office supplies and a Government calling card for business-related long distance calls.
Security
The applicant agrees to follow all existing security policies and procedures. Privacy Act data, and other sensitive or classified data may not be accessed or used from the alternate workplace. Remote access to the network will be granted, as needed.
Liability
The applicant understands that the government will not be held liable for damages to his/her personal or real property while (s)he is working at the approved alternate workplace, except to the extent the government is held liable under the Military Personnel and Civilian Employees Claims Act and the Federal Tort Claims Act.
Alternate Work Site Inspection
The employee agrees to permit the Government to inspect the alternate work site during the employee’s normal working hours to ensure proper maintenance of Government-owned property and conformance with safety standards. This is in addition to the self-certification that the employee must complete.
Work Area
An applicant working at home agrees to provide a designated work area adequate for performance of official duties.
Injury Compensation
The applicant understands that (s)he is covered under the Federal Employees Compensation Act if injured in the course of actually performing official duties at the alternate workplace. The applicant agrees to notify his/her supervisor immediately of any accident or injury that occurs at the alternate workplace and to complete any required forms. The supervisor agrees to investigate such a report as soon as possible.
Work Assignments/Performance
The employee agrees to complete all assigned work according to guidelines and standards in the employee performance plan. The applicant and supervisor agree to exercise good communication skills and work cooperatively to obtain a common understanding of expectations and desired results, and set reasonable and measurable objectives for work to be accomplished. The employee agrees to provide regular reports if required by the supervisor to help judge performance. The employee understands that a decline in performance may be grounds for terminating or modifying the telework arrangement.
Disclosure
The applicant agrees to protect government records from unauthorized disclosure or damage and will comply with requirements of the Privacy Act of 1974, 5 USC 552(a).
Standards of Conduct
The applicant agrees that (s)he is bound by official standards of conduct while working at the alternate workplace.
Cancellation
The applicant understands that the organization may cancel the telework arrangement and instruct him/her to resume working at the office. If the applicant elects to voluntarily withdraw from the program, (s)he is expected to give sufficient notice so that arrangements can be made to accommodate his/her return to a regular work schedule and (s)he must complete the Telework Termination Form.
Compliance with This Agreement
The employee’s failure to comply with the terms of this agreement may result in the termination of this agreement and the telework arrangement. Failure to comply also may result in disciplinary action against the employee if just cause exists to warrant such action.
Term
Unless canceled or terminated earlier by either the employee or the employer, this agreement shall expire on _______, unless renewed by agreement of the employee and the employer.
Certification
By signing this agreement, the applicant certifies that (s)he has read the terms of this agreement and agrees to follow the policies and procedures outlined in them as well as all other applicable policies and procedures:
__________________________________ __________________________
Applicant's Signature Date
Section II (To be completed by the supervisor and approving official)
Supervisor's Recommendation
I recommend that the application and agreement be:
- Approved as written
- Approved with the following modification:
- Disapproved for the following reason(s):
- Work not suited to telework
- Need for office coverage
- Employee is in a developmental assignment or position
- Alternate work site does not conform with safety requirements
- Employee failed to attend required training on telework
- Other (please specify):
Approving Official’s Decision
- I concur with the above recommendation.
- I disagree with the above recommendation for the following reason(s):
- Work not suited to telework
- Need for office coverage
- Employee is in a developmental assignment or position
- Alternate work site does not conform with safety requirements
- Employee failed to attend required training on telework
- Other (please specify):
____________________________________ _______________________
Approving Official’s Signature Date