Usda Telework Agreement Ad-3018
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3USDA Telework Agreement
U.S. DEPARTMENT OF AGRICULTURE
AD-3018
Check one of the following:
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The following constitutes a Telework agreement between the United States Department of Agriculture (USDA), and
(Employee Name: First, Last, Middle Initial)
detailing the terms and conditions of the Telework Program.
(Employee Official E-Mail)
(Supervisor Name: First, Last, Middle Initial)
(Supervisor Official E-Mail)
Agency/Mission Area/Staff Office:
Organization/Division:
Tour of Duty/Basic W ork Requirement:
Standard
Compressed (5-4-9)
Compressed (4-10)
Flexible (Maxiflex or Other Variable)
Other:____________________________
Work Schedule:
Full
Part-Time
Intermittent
Seasonal
Other:_______________________________________
Type of Appointment:
Full
Part-Time
Intermittent
Seasonal
Other:__________________________________
Indicate whether the employee occupies the following designation(s) during unique situations and predetermined
conditions when emergencies dictate as adopted by the Agency Coop Plan:
Emergency Essential
Mission Critical
N/A
Telework Category
Core Telework (Regular/Recurring)
Situational/Ad hoc/Unscheduled
:
Primary Telework Location
Residence
Satellite Office
Telework Center
:
The physical location at which the employee is designated to work:
(Telework Physical Address):____________________________________________________________________________
(
Street Address/ City/ State/ Zip Code)
Designated Core Telework Schedule
:
Week 1:
Monday
Tuesday
W ednesday
Thursday
Friday
Saturday
Sunday
Week 2:
Monday
Tuesday
W ednesday
Thursday
Friday
Saturday
Sunday
Employee has completed required Telework Training:
Yes Date Completed:
Supervisor has completed required Telework Training:
Yes Date Completed:
Estimated Total Number of Commuting Miles Saved Per Period:______________ Per Year:_________________
Notes
1.
This telework agreement shall correspond with the employee’s approved transit subsidy benefits. It is the employee’s responsibility to adjust
and re-certify their transit subsidy authorizations to ensure alignment with this telework agreement.
2.
Employee requests participation in the program and will adhere to the applicable guidelines, policies, and law. Agency concurs
with employee participation and agrees to adhere to the applicable guidelines, policies, and law.
3.
Employee understands that unscheduled telework or unscheduled leave may be used with supervisory notification during periods of
Unscheduled Telework authorization due to weather or other emergencies. An employee performing unscheduled or regularly scheduled
telework: 1) is expected to work all regularly scheduled hours on days when unscheduled telework is announced or to request unscheduled
leave from the supervisor; and 2) is expected to work all regularly scheduled hours when unscheduled telework is announced and weather-
related delayed arrival or early departure is authorized or request unscheduled leave from the supervisor.
Form AD-3018 Rev. (5/2014)
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