| I. Employee completes this section |
| Name
|
Date of Request
|
|
|
| Job Title/Grade
|
Component
|
|
|
| Specify the flexible work option requested (including a description of the work option,
proposed schedule, total weekly hours and proposed duration of the work option). Your
component Worklife Program Coordinator can provide guidance on available work
options in your component.
|
| |
| How will your proposed schedule sustain or enhance your and your organization's ability
to get the job done?
|
| |
| Discuss the potential problems that your changed schedule could create and how you
suggest overcoming them with each of the following groups? a) customers; b) co-workers; c) your supervisor; and d) others?
|
| |
| If applicable, describe any additional equipment/expense that your arrangement might
require.
|
| |
| Detail any short (less than 4 mos.) or long-term (4 mos. or more) cost savings that might
result from your schedule.
|
| |
| What reasonable work products and evaluation criteria would you propose for you and
your supervisor or manager to assess how your performance is meeting or exceeding
expectations? (Think about whether your Performance Work Plan is sufficient or if it
needs to be revised).
|
| |
| How frequently do you propose progress be monitored?
|
| |
| II. Manager completes this section. Upon completion of this section, one signed copy
should be given to the employee, one copy forwarded to your component Worklife
Program Coordinator and the original retained in your files. Contact your
component Worklife Program Coordinator if you would like guidance on how to
respond to the request. |
