HomeMy WebLinkAboutOCDSB 994 - Work from Home Request Form•
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Appendix A: OCDSB 994 Work from Home Request
Form (Reference: Procedure PR.701.HR Working from Home)
Please download and save this PDF fillable form. Open it, complete it, and save it again.
Provide the completed copy to your manager/supervisor as a printed paper copy, or send it as an
attachment by email. An electronic signature is acceptable.
Part A.
To be completed by the employee requesting work from home:
Employee Name:
Position: Department/Work Location:
Requested start date of work from home arrangements:
Work from home arrangement bein
� Full-time at home:
uested:
� Hybrid. Please describe your work from home arrangement below (e.g. how many
days/week):
Describe how vour iob responsibilities are suited to workinq from home:
I have discussed working from home with my supervisor and understand that my
application does not guarantee that I will be eligible to work from home. I have read the
Working from Home procedure and understand that it is not an entitlement and that it is
not operationally feasible for every position/employee. I understand that working from
home arrangements can be terminated at any time by the employer or me, subject to
the notice requirements set out in the procedure.
Employee signature: Date:
OCDSB 994
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Part B.
To be completed by the manager/supervisor, in consultation with Manager, HR (or
designate).
Please provide a summary of the considerations involved in this reauest:
Approved: Not approved (see below): Other: (see below):
Additional Comments:
Supervisor signature:
Date:
HR Manager (or designate) signature: Date:
The personal information on this form is collected under the authority of the Education Act (R.S.O. 1990
c.E2), and in accordance with the Municipal Freedom of Information and Protection of Privacy Act (RSO.
1990 c.M56), as amended. It will be used for administrative purposes in assessing work from home
requests by staff. In addition, the information may be used or disclosed to comply with legislation, for
compelling circumstances affecting health and safety, or discipline, as required in circumstances related
to /aw enforcement matters, and wifh third parties in accordance with established service agreements or
in accordance with any other Act. Questions or concerns should be directed to your supervisor, or to the
DistricYs Freedom of Information Coordinator, Ottawa-Carleton District School Board, 133 Greenbank
Road, Ottawa, Ontario K2H 6L3, Telephone 613-596-8211. CONFIDENTIAL WHEN COMPLETED.
OCDSB 994
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