Name _________________ Job Title _____________________
Department ________________ Reporting Manager __________________
Number of days I would like to telecommute in a week: __________________
Remote work location: ________________
Reason for the Hybrid work request:
HYBRID WORK APPLICANT
I'm asking for permission to work a hybrid schedule that includes working remotely, as specified in this form. I have discussed hybrid working with my supervisor and understand that my application does not guarantee that I will be eligible for hybrid working. I'm willing to return to the workplace whenever my manager thinks it's appropriate. I have read, understood, and concur to abide by the company's remote work regulations and policies. I am aware that the right to perform remote work may be revoked at any time by [Company Name]. Signing here confirms that I accept these terms and conditions.
Hybrid Work Applicants Signature ___________________
I have discussed the possibility of hybrid working with [Employee’s Name] for ________ days in a week. I approve __________ / disapprove ___________ [Employee’s Name] for hybrid working.
Supervisors Signature________________ Date ________________
Approval ___________ Disapproval ___________