Telecommuting Agreement Form

Employee Name

Job Title

Department

Supervisor Name

Telecommuting Address

Telecommuting Schedule (Days, Hours)

Effective Start Date

Expected End Date

Job Duties & Deliverables

Equipment Provided by Employer

Employer Policies & Requirements

Additional Terms

I acknowledge and agree to abide by the employer's telecommuting policies, and understand my responsibilities as a telecommuting employee.

Employee Signature

Date

Supervisor Signature

Date