TELECOMMUTING AGREEMENT

1. I,
, understand and agree that my employment with ______ (the
"Company") will be temporarily adjusted to reflect a flexible work arrangement by providing me
the opportunity to telecommute on a part-time or full-time basis as a participant in the
telecommuting program.
2. I agree that I am responsible for establishing specific telecommuting work hours, furnishing and
maintaining a dedicated remote workspace in a safe manner, employing appropriate telecommuting
security measures and protecting company assets, information, trade secrets, and systems.
3. I understand that telecommuting is voluntary and that I may stop telecommuting at any time. I
also understand that the company may, at any time, change some or all of the conditions under
which I am permitted to telecommute, or withdraw permission to telecommute entirely.
4. I understand that regardless of the type of arrangement under which I am working, business
requirements may necessitate my being in the office at times when I would normally be away from
the business premises. In such circumstances, I will adjust my hours and schedule to accommodate
the Company. If I am working on less than a full-time schedule, I understand that my compensation
and benefits may be adjusted accordingly.
5. I understand that I am subject to the guidelines set forth in ______'s Telecommuting Policy,
which I acknowledge may change from time to time at the Company's discretion. I acknowledge
that I have read ______ and that my participation in the program does not alter my status as an
at-will employee.
6. I understand that any hardware or software provided by the Company for telecommuting
purposes remains the sole property of the Company, and that this hardware and software must be
returned to the Company immediately upon request. I understand that only hardware and software
supplied by the Company have been approved for telecommuting, and that I may not install any
hardware or software not furnished by the Company on my telecommuting workstation. I also
understand that the telecommuting workstation should only be used for business purposes.
7. I agree to maintain a safe and secure work environment, and to report work-related injuries to
the supervisor at the earliest reasonable opportunity.
8. The alternate work site is ______. I understand that I am responsible for assuring that the
alternate work site conforms with zoning and similar requirements.
9. Current schedule and requested off-site schedule: ______
10. Insurance on alternate premises: ______
11. Layout of worksite or workstation: ______

12. Safety and ergonomic measures at worksite: ______

13. Job duties to be completed while telecommuting: ______
14. Company hardware and software to be used for telecommuting: ______
15. Telephone service to be used (such as Standard Voice Line, Standard Data Line, ISDN Line,
ADSL Line): ______

Employee Signature

Printed Name

Department

Date
PLEASE RETURN SIGNED FORM TO YOUR SUPERVISOR.
Received by:

Supervisor

Printed Name

Date