Dla Form 1864 - Telework Request And Approval Form

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TELEWORK REQUEST AND APPROVAL FORM
1. EMPLOYEE
2. ORGANIZATION
3. JOB TITLE
4. GRADE AND JOB SERIES
5. PHONE NUMBER
6. Last Performance Evaluation Rating
7. DESCRIPTION OF WORK TO BE PERFORMED:
8. DESCRIPTION OF OUTPUTS:
9. BENEFITS FOR EMPLOYEE AND THE EMPLOYER (CHECK ALL THAT APPLY);
Reduced Commuting Cost
Improved Productivity
Workspace Availability
Improved Morale
Reduced Parking
Incentive to remain with DLA
Promoting DLA as an Employer
Environmental Concerns
Other (Specify below)
Improved Job Access
9a. Specify Other Benefits:
10. EQUIPMENT AND SOFTWARE REQUIRED:
11. NUMBER OF COMMUTER MILES SAVED PER TELEWORK DAY:
12. START DATE
13. END DATE
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PDF (DLA)
DLA FORM 1864, JUL 2004

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