HR Telework Policy

Telework Policy and Employee Acknowledgement

Employer Identification

Employer Name:

HR Contact (Name and Title):

HR Contact Phone:   HR Contact Email:

Personal Information

Position Information

Employee Start Date:   Current Salary/Pay Rate:

Employment History (Most Recent Employers)

Title:   From:   To:

Title:   From:   To:

Education

Graduation Date:

References (Professional)

Telework Eligibility and Arrangement

Eligibility criteria: Employees approved for telework must have demonstrated satisfactory performance, have a position that permits remote duties, maintain a safe and ergonomically appropriate worksite, and be able to meet confidentiality and security obligations.

Telework Arrangement Type: Full-time telework Partial (specify days) Ad-hoc/on-call

Proposed Telework Start Date:   Proposed Schedule/Days:

Company Equipment, Security and IT Requirements

The Company will authorize and inventory any equipment provided for telework. Employee must use company-approved security measures including encrypted connections, password protection, and approved software. Employee is responsible for reasonable care of company equipment and agrees not to install unauthorized hardware or software.

Security Acknowledgement: I will use company-approved encryption and VPN when accessing company systems.
I will maintain strong passwords and not share login credentials.
I will install required security updates in a timely manner.

Confidentiality, Data Protection and Monitoring

Employee must protect confidential information and comply with applicable data protection laws and company policies. The Company reserves the right to monitor systems, networks, and work product performed on company equipment. Employee consents to reasonable monitoring and inspection of company devices and networks used for telework.

Timekeeping, Overtime, and Compensation

Non-exempt employees must obtain prior authorization for overtime and must accurately record work hours. Exempt employees must maintain regular communication with managers regarding work expectations. Telework does not alter salary, pay practices, or eligibility for benefits unless specified in a separate written agreement.

Expenses and Reimbursement

The Company will reimburse pre-approved expenses consistent with its expense policy. Routine household expenses such as utilities and internet are the employee's responsibility unless otherwise authorized in writing.

Workplace Safety and Injury Reporting

Employee is responsible for maintaining a safe work environment at the telework location. Work-related injuries must be reported immediately in accordance with company policy. The Company may conduct safety inspections with reasonable notice.

Safety Acknowledgement: I agree to maintain a safe worksite and report injuries promptly.

Revocation, Modification and Termination of Telework

Telework privileges may be modified or revoked at the Company's discretion for operational needs, performance issues, safety or security concerns, or failure to comply with policy. The Company may require return to on-site work with reasonable notice.

Compliance, Discipline and Liability

Failure to comply with this policy may result in disciplinary action up to and including termination. Employee acknowledges that personal liability for non-company equipment remains the employee's responsibility; the Company is not responsible for loss or damage to employee-owned property unless otherwise agreed in writing.

Legal Disclosures

At-Will Employment: Participation in telework does not alter the at-will nature of employment. Either the Company or the employee may terminate the employment relationship at any time, with or without cause or notice, subject to applicable law.

Equal Employment Opportunity: The Company provides equal employment opportunities without regard to protected characteristics. Telework assignments and accommodations will be considered consistent with applicable law and Company policy.

Authorization to Contact and Background Checks

By signing below, the employee authorizes the Company to contact prior employers and references listed in this form to verify employment history and qualifications. The employee further consents to background checks as permitted by law when required by the Company.

Authorization: I authorize contact with prior employers and consent to background checks as required.

Acknowledgement and Employee Certification

I certify that all information provided in this document is true and complete to the best of my knowledge. I have received, read, and understand the Telework Policy. I agree to comply with the policy, company procedures, and applicable law. I understand that failure to follow the Telework Policy may result in revocation of telework privileges and may subject me to disciplinary action.

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