Employee Name:Supervisor Name:

Requested telework schedule (by pay period):

Job Title:

Week 1: S M T W Th F Sa

Week 2: S M T W Th F Sa

EMPLOYEE INFORMATION

COMMANDER NAVY RESERVE FORCETELEWORK REQUEST FORM

(FOR "ELIGIBLE" EMPLOYEES ONLY)

I have reviewed the employee's position, the supervisor's recommendation, and the proposed Telework Agreement. Based on this review I have determined that telework should be: Approved Denied

________________________________________ ____________________Signature of Approving Official DateIf approved, this form and the proposed Telework Agreement are to be returned to the appropriate supervisor for signatures.

If denied, comments outlining the reason(s) for the decision are to be documented below, and the form and agreement are to be returned to the supervisor for proper routing. This decision is final and is not appealable, grievable, or subject to review.

Comments:

AUTHORIZED OFFICIAL APPROVAL

EMPLOYEE SIGNATURE

Type of Telework Request: CORE - Work performed at an alternate worksite on a routine, regular, and ongoing basis.

SITUATIONAL - Work performed at an alternate worksite for a short period of time, as needed.

COOP - Continuity of Operations Plan (COOP)

Alternate Worksite Address: Home: Other:

SUPERVISOR APPROVALI have reviewed the position and employee eligibility criteria and the needs of the organization. Based on this review, I have determined that telework should be: Approved Denied

________________________________________ ____________________Signature of Supervisor Date

I have read the Telework Policy and completed the Telework Training and reviewed the contents of the Telework Agreement.

________________________________________ ____________________Signature of Employee Date

If approved, this form and the proposed Telework Agreement are to be forwarded to the Approving Official for review.

If denied, comments outlining the reason(s) for the decision are to be documented below and the request is to be returned to the employee. This decision is final and is not appealable, grievable, or subject to review .

Comments:

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iris.lewisTypewritten TextNAVRES 1000/8 (5-14)

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Telework Request Form

Employee Name: Job Title: Supervisor Name: Alternate Worksite Address: Supervisor Date: Supervisor Comments: Approving Official Date: Approving Official Comment: Home Worksite: OffOther Worksite: COOP Telework: Off1Tues: Off1Wed: Off1Thurs: Off1Fri: Off1Sat: Off2Mon: Off2Tues: Off2Wed: Off2Thurs: Off2Fri: Off2Sat: OffSupervisor Approved: OffSupervisor Denied: OffApproving Official Approved: OffEmployee Date: Approving Official Denied: Off2Sun: Off1Mon: Off1Sun: OffSituational: OffCore: Off