ALTERNATE WORK ARRANGEMENT REQUEST FORM
The purpose of this form is to request and document any alternate work arrangement (AWA) request and approval by the supervisor, unit leader and UTFI Human Resources. Please review UTFI human resources policy 7.20 for information on the general guidelines, expectations and eligibility.
Employee Name
*
Employee Email
*
example@example.com
Please select only ONE that applies:
*
Please Select
Modify Existing
New Request
Start Date
*
-
Month
-
Day
Year
Date
Supervisor Name
*
Supervisor Email
*
example@example.com
Campus
*
Please Select
UTK
UTIA
HSC
UTM
UTS
Please indicate up to 3 specific workday(s) for which you are requesting an alternate (out-of-office) schedule in accordance with the AWA.
Monday
Tuesday
Wednesday
Thursday
Friday
Remote Work Location Address
*
i.e. home address, alternate office address, etc.
Equipment/supply requirements. Are there any UTFI equipment that will be utilized while on an approved AWA? If so, please enter the type of equipment & necessary blue tag information. (i.e. computer, printer, monitor, iPad, camera, keyboard/mouse, etc.)
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Employee Signature - By signing this request form, I acknowledge and understand the terms and expectations as outlined above and in UTFI human resources policy 7.20 Alternative Work Arrangement (AWA). I understand that this AWA request and subsequent approval may be changed or discontinued at any time.
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Employee Signature Date
*
-
Month
-
Day
Year
Submit
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