Remote Work Form

1
Name* This field is required.
First Name
Last Name
2
Email Address* This field is required.
example@example.com
3
Cell Phone Number* This field is required.
4
What time-period are you requesting a remote workday from?
Please Select
Please Select
September 10-January 10 / February 10-June 1
June 1 - August 1
5
How many remote workdays are you requesting this month?* This field is required.An employee can request up to two remote days per month from September 10-January 10 and from February 10-June 1.
One
Two
6
How many remote workdays are you requesting this summer month?* This field is required.An employee can request up to one remote day per week from June 1-August 1.
One
Two
Three
Four
7
Remote Work Day #1
Date
Month
Day
Year
8
Remote Work Day #2
Date
Month
Day
Year
9
Remote Work Day #3 (only for June 1-August 1)
Date
Month
Day
Year
10
Remote Work Day #4 (only for June 1-August 1)
Date
Month
Day
Year
11
Next Steps

After email approval, please indicate the remote day on both your Outlook and Jason's Outlook calendars in the 7 AM - 8 AM time slot.

Remote Work Reminder

The number of hours a remote employee is expected to work does not change, regardless of work location. We expect the same level of productivity from someone working remotely as from someone who works on campus. Remote employees are responsible for adhering to the same schedule that is worked when on campus. Employees unable to work their full schedule must use the time off. Remote work should not replace sick, personal, or vacation days.
12
Please verify that you are human* This field is required.
Should be Empty: