VCOM Institutional Policy and Procedure Manual

12. Please provide the expected work schedule for on-campus and off-campus remote work: ______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ 13. When working remotely, what will be the requestor’s (employee) availability: ______________________________________________________________________________ ______________________________________________________________________________ 14. Contact Person and Contact Information (to reach the remote worker for urgent or emergent issues):

Name: ___________________________ Phone: ___________________________

By completing this form, I am aware that certain limitations, restrictions, and constraints may apply. I understand that my Remote Work Request will be evaluated on a case-by-case basis including, but not limited to, the reasons for the request and the overall needs of the requestor’s (employee) department. I understand that any approved Remote Work Request shall be on a provisional basis and subject to a 60-day trial period for supervisor review. I further understand that approvals will be periodically reviewed for their effectiveness, and the College reserves the right, in its sole discretion, to modify or terminate the remote work arrangement at any time. Employees who have been approved for remote work are not guaranteed the opportunity of on-going remote work. Employees may be required to return to campus if deemed as having performance or work conduct problems or if the College concludes it is in the best interest of the College to temporarily or permanently modify or suspend the remote work arrangement. I understand that employees, approved for remote work, are subject to all College policies and procedures, regardless of work location, and must comply with all College rules, policies, handbooks, practices, and instructions. Violations may result in the termination of the remote work arrangement and/or disciplinary action, up to and including dismissal. Additionally, neither this policy nor the remote work agreement alters any employee contract language or the at-will employment relationship in any way, and the employee’s employment remains at-will.

Employee Signature: ____________________________________

Date: ______________

Approvals

Immediate Supervisor: ____________________________________

Date: ______________

Division Officer:

____________________________________

Date: ______________

Campus Dean:

____________________________________

Date: ______________

President/Provost:

____________________________________

Date: ______________

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