Telecommuting Agreement Form

Columbia University
Telecommuting Agreement Form

Employee Name:
Social Security Number:
Job Title:
School / Administrative Unit:

Effective , you are authorized to perform your job responsibilities as a telecommuter working from a remote work location. This agreement and the University's telecommuting policy describe the terms and conditions of this telecommuting arrangement.

If work schedule varies week to week, please note below.

If other than core business hours (9 am to 5 pm):
Scheduled hours: From am / pm to am / pm

University Property Loaned to Employee:

Quantity	Equipment Description, Model and Serial Number	Condition

Other terms and conditions of telecommuting agreement, if any:

If this arrangement is for a specific period of time, indicate termination date of telecommuting arrangement:

This agreement does not constitute a contract of employment, and should not be interpreted as creating a contract of employment, either express or implied. The employment relationship between the University and the employee is one of employment at will, and may be terminated by either party at any time.

Check One:

	This telecommuting agreement may be terminated by the University or the employee at any time and for any reason.
	This telecommuting agreement is a condition of employment and may not be terminated by the employee. The University may terminate this agreement as provided in ``Duration."

Employee Agreement:

I have read the contents of this contents of this telecommuting agreement and the University telecommuting policy. I agree to abide by all of the requirements of the policy and of this agreement.

_____________________________	______________________
Employee Signature	Date

University Approval:

The above-named employee has met all of the terms and conditions of the University telecommuting policy, and approval is granted for the employee to participate in accordance with the agreement set forth above.

_____________________________	______________________
School/Administrative Unit Approval	Date

Copies:
Original to be retained by School/Administrative Unit.
One copy to be provided to employee.
One copy to be forwarded to Human Resources Information Services (1901 Interchurch, Mail Code 7705) for Morningside and Health Sciences Human Resources (112 Black Building) for Health Sciences.