Home Employers     Log In     Pricing    Find Candidates    Family Friendly Job Seekers      Log In     Find Flexible Work      Find Job Share Partner         Resources      Job    Home Business    Pay    Articles      Links       About Us	TELEWORK SCREENING QUESTIONNAIRE/APPLICATION This document is developed to obtain certain information relative to whether or not the employee, his or her job, and his or her home work environment are suitable for a teleworking arrangement.  Name:__________________________ Date:__________________ I.D. Number:_____________ Department:_____________________ Title:________________________ Supervisor:__________________ What are your primary job responsibilities? Which of these responsibilities do you believe are conducive to teleworking and how? What qualities do you possess which make you a potential candidate for a telework arrangement? How will you arrange any meetings or central work location issues which may be scheduled and/or necessary during the telework arrangement? How many days per week do you propose to telework? Do you have an area in your home which is conducive to home work? Please describe in detail or attach a detailed diagram or sketch of the home work area: What kind(s) of equipment would be required in your home work area to facilitate the telework arrangement? If applicable, do you have the equipment necessary to perform your required work tasks within the home work area? Please describe available equipment: Have you had any documented performance problems or disciplinary actions during the pervious two (2) years? If yes, please describe: Have you read and are you familiar with the Telework Policy? Why do you think a telework arrangement is beneficial both to yourself and the Organization? If my proposal for a telework arrangement is approved, I hereby agree to abide by the terms of the Organization Telework policy, any applicable business unit telework policy, The Telework Agreement and all other Organization policies and procedures.   Employee's Signature & Date Teleworking Policy Telework Agreement
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