HUMAN RESOURCES
TELECOMMUTING EMPLOYEE AND SUPERVISOR AGREEMENT
Employee Name:
_________________________________________
Department:
_________________________________________
Supervisor Name:
_________________________________________
Agreement Dates:
____________________
Begin Date
____________________
End Date
Dates for telecommuting agreement review: _________________________________________
1. The employee will work at:
__________________________________________________________________________________________________
Complete address
Is remote location out of state? Yes/No
If yes, contact Payroll to ensure appropriate taxes are withheld.
2. The employee’s designated remote work location (e.g., home office section) will include the following:
Instructions for Question 3
For FLSA Exempt Employees:
a) If subject to a structured work schedule, complete all of question 3.
b) If not subject to a structured work schedule, complete just the Total Telecommuting Hours per Day.
For FLSA Non-Exempt Employees:
Complete all of question 3. Advance supervisory approval is required to vary from the stated times.
3. The employee’s telecommuting work schedule will be:
Days of the Week
Start Time
Finish Time
Breaks
(if applicable)
Total
Telecommuting
Hours per Day
Gonzaga University Human Resources ~ www.gonzaga.edu/hr ~ 509-313-5996 ~ 102 E. Boone Ave., Spokane, WA 99258
4. The position description outlines job duties the employee will perform at the remote work location and at the
university job site. (Update the position description so it clearly delineates where each job duty will be
performed.)
5. The employee will/will not be given a monthly/yearly technology and communication allowance.
6. Business telephone calls made from the remote work location will be paid for as follows: employee
reimbursement, and/or technology and communication allowance.
7. The decision whether to install telecommunications equipment (e.g., cable modem, DSL, frame relay line,
telephone line, ITFS, etc.) will be made between the supervisor and the employee. If such equipment is
installed, the expenses for the installation will be covered by the employee. Recovery of monthly service costs
can be applied for through the technology and communication allowance.
8. Data calls made from the employee’s remote work location with a personal computer will be paid through
the technology and communication allowance. The business use of communication devices (phone, internet
access, etc.) will be paid by the technology and communication allowance.
9. University equipment will/will not be used at the remote work location.
University equipment given to the employee:
Telecommuting employees may want to look into insuring Gonzaga University-provided equipment used for
Gonzaga University business under his/her homeowner’s or renter’s insurance policy. This equipment should be
specifically identified by description and value in his/her homeowners or renters insurance policy. Employees
who live in rented property should be aware that their lease may not permit business use of the premises.
Employee’s Initials: _______________
Supervisor’s Initials: _____________________
10. Communication between the employee and his/her office (e.g., e-mail, voice mail, etc.) will be handled as
follows:
11. Additional conditions agreed upon by the telecommuting employee and the supervisor are as follows:
Gonzaga University Human Resources ~ www.gonzaga.edu/hr ~ 509-313-5996 ~ 102 E. Boone Ave., Spokane, WA 99258
I have read and understand the Gonzaga Telecommute Policy, Gonzaga University’s Acceptable
Information Technology Use Policy and this agreement. I agree to abide by and operate in accordance
with the terms and conditions outlined in these documents. I agree that the sole purpose of this
agreement is to regulate telecommuting and it neither constitutes an employment contract nor an
amendment to any existing contract. I understand that this agreement may be terminated at any time.
Employee
Date
Supervisor
Date
Vice President
Date
Information Technology Services
Date
Once this form is completed and signed, please submit this form to Human Resources, AD Box 80. Thanks!
Gonzaga University Human Resources ~ www.gonzaga.edu/hr ~ 509-313-5996 ~ 102 E. Boone Ave., Spokane, WA 99258