Section I: Employee Information
Fill out all the information. Make sure to select exempt or non-exempt.
Section II: Exempt Employee
If you’re an exempt employee, check to acknowledge, “I have read the information above for exempt employees.”
Section III: Non-Exempt Employee
If you’re a non-exempt employee, check to acknowledge, “I have read the information above for non-exempt employees.”
Section IV: Additional Comments Regarding Remote Work Schedule
Write the remote work schedule. For example, Monday, Wednesday, and Thursday (onsite); Tuesday and Friday (remote).
Section V: Agreement Dates and Terms
Agreement Effective Date – The date when the employee will start working remotely.
Check one box:
– If the employee has a set end date for remote work, provide the remote work end date.
– Most employee will be on an indefinite schedule unless their schedule changes.
Remote Work Location – The location where the employee will be working remotely, for example, employee’s home.
Onsite Work Location – Student Center G308, Student Center, Irvine, CA 92697
Acknowledgement – Check the acknowledge, “I have read and understand this Agreement and …”
Section VI: Signatures
– Employee Name, Signature, Date
– Supervisor Name, Signature, Date
– Department Head Name: Rameen Talesh Ed.D., Associate Vice Chancellor SLL, Signature, Date
After obtaining all the signatures, please send the agreement to Dwuena Wyre, Sr. HR Business Partner for review and approval, and CC the Department HR Representative, Sunny. For Docusign purposes, Dwuena Wyre will be the local HR Contact. Please ensure that the completed agreement is sent to Sunny for filing.