Telecommute Form

Employee Name(Required)

Employee ID(Required)

Employee Title(Required)

Employee's Email(Required)

Department(Required)

Immediate Supervisor's Name(Required)

Supervisor's Boise State University Email(Required)

Supervisor's Work Phone(Required)

Where will the employee be working?(Required)

Idaho
Outside of Idaho

Have you received approval from your chain of command up to the Provost or Vice President level?

Yes
No

Approval is needed from your chain of command up to the Provost or Vice President's Office. Please continue to complete this form ONLY IF you are currently or will be shortly working outside of Idaho to ensure you are taxed correctly while you gain approval.

Is this form being submitted for medical, FMLA, or ADA reasons?(Required)

Yes
No

ADA Approval Letter

I have received an ADA approval letter for telecommuting from Human Resources
I have not received an ADA approval

Stop here and contact HR benefits at hrs@boisestate.edu and request an ADA accommodation before proceeding.

Start Date of Proposed Telecommute Arrangement *(Required)

For employment tax purposes a definitive start date is required for employees telecommuting from Alternate Work Locations outside the State of Idaho.

End Date of Proposed Telecommute Arrangement *(Required)

The end date must not be more than a year from the start date. A new Telecommute Agreement Form must be completed each year.

Physical Work Address(Required)

If the location is in remote areas or has no specific address, use the closest town or city.

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Will the work location change during the employment?(Required)

Yes
No

*Note: If your work location changes during employment you will need to complete a new Telecommute Agreement.

Employee's Current Work Schedule(Required)

(Include days p/wk, hrs/day, mos/yr)

How often will the employee telecommute?(Required)

Select an option listed or type in other applicable information in the other edit box

Once every week
Two days a week
Three or four days a week
All work will be conducted off-site

Work Environment(Required)

Describe your work environment, physical demands, and details of your activities in a typical workday. (Example: typical office setting entering data, outside capturing birds, hiking in the mountains to collect water samples, etc.)

Department Specific Expectations(Required)

Department Specific Expectations: (Insert any department-specific requirements; frequency of communication, response time, etc.)

You must agree to the following terms:(Required)

Employee's Signature:(Required)

Your e-signature certifies you will abide by the terms of this Agreement, all applicable telecommuting policies, and all Agreement-specific terms established by the University. The language used in this Agreement does not create an employment contract between the employee and the University. This Agreement does not create any contractual rights or entitlements, but, instead, establishes conditions for permitting an employee to qualify for and continue to exercise the privilege of telecommuting. The University reserves the right to revise the content of this Agreement or its terms, in whole or in part, at its discretion. No promises or assurances, whether written or verbal, which are contrary to or inconsistent with the terms of this paragraph are binding upon the University.

Date(Required)

If you do not receive a notification after submitting this form, please inform telecommuting@boisestate.edu.

Telecommute Form

Form

Human Resource Services