Telecommuting Agreement

Telecommuting Agreement

Employee Name:

Company Name:

Employee ID #:

Department:

SSN:

Supervisor Name:

Start Date:

End Date:

Terms

Employee’s Remote Work Location:

Work Space Entails:

Equipment Needed:

Paid for By:

Schedule

Telecommuting Days:

Monday

Tuesday

Wednesday

Thursday

Friday

Telecommuting Hours:      Start:

End:

Break Times:

Total Amount of Time:

In-Office  Days:

Monday

Tuesday

Wednesday

Thursday

Friday

In-Office  Hours:               Start:

End:

I have read and understand the telecommuting agreement policy for the aforementioned company. I agree to abide by the terms and conditions outlined in those documents. I understand that this contract may be terminated at any time.

Employee Signature:

Date:

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