Work From Home Request Form

Purpose: This form is used by employees to formally request a temporary or permanent work-from-home arrangement. Approval is subject to review by the relevant department supervisor and human resources.

Employee Information

Full Name: {fullName}
Job Title: {jobTitle}
Department: {department}
Employee ID: {employeeId}
Email Address: {email}

Request Details

Type of Request: {requestType} (Permanent or Temporary)
Requested Start Date: {startDate}
Requested End Date: {endDate}
Reason for Request:
{reason}

Work Schedule

Indicate your proposed remote work schedule below:

Home Office Setup

{#hasHomeOffice}

• Has a dedicated workspace: {workspace}
• Has necessary equipment: {equipment}
• Internet Speed: {internetSpeed}

{/hasHomeOffice}

{^hasHomeOffice}

The employee does not currently have a home office setup and may require additional resources or time to establish one.

{/hasHomeOffice}

Manager Approval

Manager Name: {managerName}
Date of Review: {reviewDate}
Status of Request: {approvalStatus} (Approved/Rejected/Pending)
Comments:
{managerComments}

Employee Acknowledgment

I, {fullName}, understand that by submitting this form I agree to adhere to company policies regarding remote work. I agree to maintain productivity and communication standards while working from home.

Signature: _______________________     Date: {submissionDate}