Staff Telework Agreement Form

	Work Location
Monday
Tuesday
Wednesday
Thursday
Friday

I have read LCC's Telework Procedure and agree to comply with the procedure during my telework hours.*

YesNo

I understand that when the campus is closed due to weather or other emergency and all operations are suspended, the suspension also applies to those who are teleworking unless I am requested by my supervisor to work.*

YesNo

I will follow College confidentiality policies and procedures while teleworking.*

YesNo

I will keep my Supervisor informed of progress on assignments and any problems that may arise while teleworking.*

YesNo

I will be available to my supervisor, students, co-workers, and the public during scheduled faculty hours via phone, phone messaging, and/or email. I will notify my supervisor in the event that there is an emergency or circumstance that causes me to be unavailable.*

YesNo

I agree to keep my cell phone updated in ctcLink.*

YesNo

I will maintain safe working conditions and practice appropriate safety habits while teleworking.*

YesNo

I will notify my supervisor if I will be teleworking outside of my specified telework location (i.e. state). These telework arrangements may require additional approval to ensure the College's legal obligations are met.*

YesNo

I understand that this Telework Agreement may be terminated at any time by myself or the College.*

YesNo

Lower Columbia College does not discriminate on the basis of sex and prohibits sex discrimination in any education program or activity that it operates, as required by Title IX, including in admission and employment. Lower Columbia College provides equal opportunity in education and employment and does not discriminate on the basis of race, color, national origin, citizenship or immigration status, age, perceived or actual physical or mental disability, pregnancy, genetic information, sex, sexual orientation, gender identity, marital status, creed, religion, veteran or military status, or use of a trained guide dog or service animal as required by Title VI of the Civil Rights Act of 1964, Title VII of the Civil Rights Act of 1964, Title IX of the Educational Amendments of 1972, Sections 504 and 508 of the Rehabilitation Act of 1973, the Americans with Disabilities Act and ADA Amendment Act, the Age Discrimination Act of 1975, the Violence Against Women Reauthorization Act and Washington State's Law Against Discrimination, Chapter 49.60 RCW and their implementing regulations. All inquiries regarding compliance with Title IX, access, equal opportunity and/or grievance procedures should be directed to Vice President of Foundation, HR & Legal Affairs, 1600 Maple Street, PO Box 3010, Longview, WA 98632, title9@lowercolumbia.edu, Phone number, (360) 442-2120, Phone number/TTY (800) 833-6388. The notice of nondiscrimination is located at https://lowercolumbia.edu/disclosure/non-discrimination/.

Staff Telework Agreement Form

Telework effective dates

Out-of-State Work Location

Use the table below to indicate your telework schedule

Acknowledgements