Temporary Alternative Work Arrangement Agreement for Faculty Employees

Temporary Alternative Work Arrangement Agreement for Faculty Employees
Employee Name *

First Name Last Name
Employee's Email Address *
Use @wiu.edu email address
Department Name *
Supervisor's Name *

First Name Last Name
Supervisor's Email Address *
Use supervisor's @wiu.edu email address. Must be correct in order for approval to be processed
Frequency of alternative work arrangement (i.e. daily each week, on the same day every week, or on some routine basis) *
- This Agreement is between the department and Employee to establish the terms and conditions for temporarily performing work at an alternate worksite or schedule based on the frequency noted above.
- This Agreement will remain in effect unless altered or terminated at any time as described in the Temporary Alternative Work Arrangement Guidelines .
Agreement is effective beginning on: *

Month Day Year
Date
The following conditions apply (please complete all that are applicable)
Faculty member’s class and office hour schedule as indicated on your syllabi or communication plan (specify days and hours):
Employee’s alternative work site location is (administrative use only):
Employee's alternative work phone number is (administrative purposes only):

Area Code Phone Number
Describe any essential duties that will require the employee to report to their normal work location:
List any University owned property (with WIU ID Tag) that will be utilized at a remote location:
By clicking "Submit," I hereby affirm that I have read the Temporary Alternative Work Arrangement Guidelines and understand and agree to the duties, obligations, responsibilities, and conditions described in the guidelines and this document.

I agree that, among other things, I am responsible for establishing specific alternative work hours consistent with the quantity of normal work hours, furnishing and maintaining my work space in a safe manner, respecting established protocols, and employing appropriate measures to protect University assets and information.

I also understand that the University may at any time terminate or change any or all of the conditions under this Temporary Alternative Work Arrangement Agreement. I also agree that I will return all University owned property within 48 hours of termination of this agreement.

A copy of this Agreement will be sent to Academic and Administrative Personnel prior to the effective date and will be placed in the Employee's personnel file. The employee and the supervisor should each keep a copy of this Agreement for future reference.
Should be Empty:

Temporary Alternative Work Arrangement Agreement for Faculty Employees

The following conditions apply (please complete all that are applicable)