Telework/Remote Work Agreement

Name*

First NameLast Name

Your PNWU Email*

example@example.com

Job Title*

Supervisor's Name*

Supervisor's Email*

example@example.com

All University policies and procedures continue to apply while an employee is teleworking or remote working. Of special note for remote and telework are the following:

Attendance and timekeeping procedures must be adhered to, including accurately recording all working time, paid time off, and unpaid time off.
Hourly employees must take meal periods and rest breaks.
Hourly employees teleworkers or remote workers are not expected, required, or authorized to perform any duties outside their regularly scheduled work hours or their designated workspace at the teleworking site.
Similarly, hourly employees, teleworkers or remote workers are not on call or otherwise expected to respond to communications outside their regularly scheduled work hours.
Teleworkers and remote workers must report to their supervisor any work-related injury, hazards, theft, or loss and allow agents of the University to investigate and inspect the telework site if necessary.
Teleworkers required to be at an alternative work site that is more than 50 miles from their primary telework address will be reimbursed as described in the Pay for Travel and Expense Finance Page on MyPNWU. Travel for remote workers to meet on campus is not covered.
Accommodation granted pursuant to the University’s accommodation policy.
Teleworkers and remote workers must have dependent care arrangements allowing them to concentrate on their work assignments. If teleworking or remote working is approved to allow a non-exempt employee to accommodate family obligations, such as caring for a dependent, the employee must use paid or unpaid time off, in accordance with the University’s policies, for the portion(s) of the day spent caring for a dependent rather than working.

Anticipated telework/remote start date

Date

Primary telework physical address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

What type of telework arrangement are you seeking?*

Remote – Positions designated to work entirely off-campus with no on-campus workspace accommodations. Remote workers are generally limited to the PNWU 5-state catchment area.Telework – Employees perform the duties and responsibilities of the position from an approved worksite other than the location from which the employee would routinely work. Teleworkers are geographically closer to the main office location than a remote worker and may need to report to the main office/campus on a semi-regular or as-needed basis. A teleworker typically does not have on-campus workspace accommodations.Hybrid/occasional telework - Arrangement where employee's official work location is on campus but telework is not regularly scheduled.

If you selected telework above, have you confirmed with your supervisor you have a location on campus to use or share? Please list the location and who you’re sharing it with, if known.

Campus building, room number

What PNWU equipment will you be using remotely?

Example: laptop, two monitors, docking station, keyboard.

Telework and Remote Work Details

	Start Time	End Time	Telework	On-Campus
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday

Hybrid/occasional Telework Details

Please confirm the below.*

I have discussed telework with my supervisor and we have agreed on a communication strategy.I’ve read and understand the Remote Access and Telework Requirements on myPNWU.I’ve read and understand the Telework Policy.I’ve read and understand other relevant policies, including Information and Data Retention, Network Acceptable Use, and Records Retention and Disposition.

A copy of the submitted form will go to Human Resources, your supervisor, and you HR will be in contact with you to confirm.

If you have any questions about filling out this form, please direct them to hr@pnwu.edu.

Telework/Remote Work Agreement

Applicable Policies to Telework and Remote Work

Telework/Remote Work Details