Telework Policy Document

TELEWORK POLICY DOCUMENT

Personal Information

Full Name:

Position Information

Company Start Date:

Employment History (Most Recent)

Dates Employed: From to

Employment History (Prior)

Dates Employed: From to

Education

Graduation Date:

References

Telework Eligibility and Agreement

Telework Type: Please indicate the telework arrangement requested and approved. Select all that apply.

Full remote    Part-time remote    Hybrid (schedule below)

Requested Telework Start Date:

Approval Conditions: The employer may condition telework approval on business needs, job duties, past performance, and completion of required security safeguards. The employee agrees to comply with the conditions set forth below and any additional written terms provided by the employer.

Work Schedule, Availability, and Location

Employee must be available for meetings, on-call duties, and reasonable in-person attendance as required by management. Failure to maintain agreed availability may result in revocation of telework privileges.

Equipment, Security, and Data Protection

Equipment Provided by Employer: The equipment list below, if any, is provided on loan and remains company property. Employee must protect, maintain, and return equipment upon request or separation.

Data Security Obligations: Employee shall implement and maintain safeguards to protect confidential and proprietary information, including use of employer-approved VPN, strong passwords, regular software updates, and immediate reporting of security incidents. Unauthorized disclosure or failure to implement required safeguards may result in disciplinary action, up to and including termination.

Health, Safety, and Workers' Compensation

Employee is responsible for maintaining a safe work environment while teleworking. Any work-related injury sustained while teleworking in an approved work area must be reported promptly to the employer in accordance with company reporting procedures. The employer retains the right to inspect the telework workspace with reasonable notice to ensure compliance with safety standards.

I acknowledge that I will maintain a safe and ergonomically appropriate workspace and will promptly report work-related injuries.

Expense Reimbursement

Unless otherwise authorized in writing, the employee is responsible for ordinary household expenses (internet, utilities). Employer may reimburse pre-approved, reasonable business expenses in accordance with the company's expense reimbursement policies and upon submission of itemized receipts.

I have read and agree to follow the employer's expense reimbursement procedures when seeking reimbursement.

Performance, Supervision, and Monitoring

Employee performance while teleworking is subject to the same performance standards as on-site work. The employer may require status reports, completion of productivity metrics, and reasonable supervision methods. Monitoring may include activity logs, virtual meeting attendance, and outcome-based deliverables.

Termination or Modification of Telework Arrangement

Telework privileges are a conditional job benefit and may be revised, suspended, or terminated by the employer at its discretion for business needs, performance issues, policy violations, or other legitimate reasons. Employee agrees to return to on-site work upon reasonable notice.

Notice Period for Modification/Termination (if any):

Legal Disclosures

At-Will Employment: Nothing in this Telework Policy shall be construed to modify the at-will employment relationship between the employer and the employee, unless a separate written agreement signed by both parties expressly states otherwise.

Equal Employment Opportunity: The employer is an equal opportunity employer. Telework decisions will be made without regard to protected characteristics, consistent with applicable law.

Authorization and Background Checks

By signing below, the employee authorizes the employer to contact prior employers and listed references for verification of employment and to conduct background, criminal history, and other pre-employment or ongoing checks as permitted by law for the purpose of evaluating telework eligibility and continued participation.

I authorize contact with prior employers and consent to background and reference checks as permitted by law.

Acknowledgment and Employee Certification

I certify that all information provided in this Telework Policy Document is true and complete to the best of my knowledge. I acknowledge that I have read, understand, and agree to comply with the terms and conditions of this Telework Policy. I understand that violation of this policy may result in disciplinary action, including revocation of telework privileges and up to termination of employment.

I further certify that I will safeguard confidential information, comply with data protection requirements, and return all employer property upon request or at the end of my telework arrangement or employment.

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