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Flexible Work Arrangement - Agreement Form

Effective Date: Review of Agreement Date:Employee Name: Employee ID:Phone: Email Address:Department Name: Job Title:Department Address: Non-exempt Academic Staff Non-exempt Administrative Staff Exempt Academic Staff Exempt Administrative StaffLabor Group (if applicable): BTC CWA CPU IUOE UAW SPFPA IUOE UAW Arrangement (check all that apply): Change to standard start/end time Compressed work schedule ( four 10hr. days per week) Remote work (complete pages 2-3) Job Share (complete page 4)Standard work HoursNew HoursWork RemotelyJob share with (name):Sunday Monday Tuesday Wednesday Thursday Friday Saturday I have read and understand the above/attached Arrangement .

Arrangement (check all that apply): Change to standard start/end time Compressed work schedule (e.g. four 10hr. days per week) Remote Work (complete pages 2-3) Job Share (complete page 4) Standard Work Hours New Hours

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