Voluntary Participation
Employee voluntarily agrees to work at the approved alternative worksite indicated below and to follow all applicable policies and procedures. Employee recognizes that the telecommuting arrangement is not an employee benefit.

Official Duty Station
The Employee’s official duty station is the employer’s office located at ________________. The Employees alternative work site is ___________.

Work Schedule and Tour of Duty
Employing Office and Employee agree that the Employee’s official hours will be: ____________
Employee understands that the Employing Office has the discretion to determine or change the telecommuting schedule.

Cancellation of Agreement
Employee understands that the Employing Office may cancel the telecommuting arrangement and instruct the employee to resume working at the central work site. Subject to its needs and availability of space, the Employing Office agrees to let the employee resume his or her regular schedule at the central work site after notice to the Employing Office. In the event that the employment relationship is terminated, all items that are the property of the Employing Office/House of Representatives will be returned at the convenience of the employing office.

Office Equipment
The Employing Office and/or the House of Representatives may pursue recovery from the Employee for property belonging to the Employing Office that is deliberately, or through negligence, damaged, destroyed, lost or stolen while in the employee’s care, custody, or control. The Employee is responsible for reimbursement for theft, damage or destruction of Employing Office property at the alternative work site. Repair and/or replacement costs and liability for privately owned equipment and furniture used during telecommuting are the responsibility of the Employee.

Special Provisions
As discussed in the Telecommuting Policy, there are some provisions to the agreement that are unique to the individual employee. These provisions are as follows:

[list any unique provisions of individual agreement here, i.e. hours,
employing office information, designated telecommuting days]

Trial Period
The continuation of the telecommunicating arrangement is subject to a _____ week/month trial period. This trial period will commence on _____ and will end on __________. This trial period does not alter the Employing Office’s ability to terminate the telecommuting arrangement or employment relationship at any time with or without cause, so long as such action does not violate applicable law or House Rules.

Reimbursement Costs
The following is an exclusive list of costs reimbursable to the employee:

[list of specific reimbursement costs]

Other Action
Nothing in this agreement precludes the Employing Office from taking any appropriate disciplinary or adverse action against an employee who fails to comply with the provisions of the Telecommuting Policy or any policies and procedures adopted by the Employing Office and/or the House of Representatives.

Telecommuting Implementation Checklist

Action Completed	Date	Employee/Employer Initials
1. Employee has read guidelines stating the policies and procedures of the program.
2. Employee has been provided with the work schedule.
3. Employee has been issued equipment.
4. Equipment issued has been inspected.

Condition range: poor, good, excellent, new:

1. __ computer (condition: __________________)

2. __ modem (condition: __________________)

3. __ fax machine (condition: __________________)

4. __ telephone (condition: __________________)

5. __ other (describe on separate attachment)

Action Completed	Date	Employee/Employer Initials
5. Policies and procedures for care of equipment issued by the Employing Office have been explained and are clearly understood.
6. Policies and procedures covering classified secure, confidential and/or private information have been discussed, and the employee certifies that those requirements are met.
7. Requirements for an adequate and safe office space and/or area have been discussed, and the employee certifies those requirements are met.
8. Employee understand that he or she is required to comply with all Rules of the House of Representatives, as well as any and all applicable laws, regulations and guidelines, including those of the Committee on Standards of Official Conduct.

Action Completed	Date	Employee/Employer Initials
9. Performance expectations have been discussed and are clearly understood.
10. Employee understands that the Employing Office may terminate employee participation at any time.
11. Employee understands that failure to comply with the telecommuting guidelines may subject him/her to disciplinary action up to and including termination.

The Employee agrees that he/she has read and understands the Telecommuting Policy and this Agreement and agrees to abide by the provisions therein.

Employee’s Signature _____________________ Date: _____________

Employing authority’s Signature _____________________ Date: _____________

Approved [ ] Disapproved [ ]

[Welcome] [Telecommuting Policy] [Sample Agreement] [Security Guidelines] [Forms]