Remote Location Change - Request Form - Executive Office Shared Environment

Preparer Information

Preparer Name(Required)

Your name

First

Last

Preparer UW Email(Required)

Your UW email address

Alternate Contact

In the event of your absence, who should be contacted?

First

Last

Alternate Contact UW Email

Alternate contact's UW email address

EO Assistance(Required)

Did you consult with or receive assistance from an Executive Office Shared Environment team member prior to filling out this form?

No

Yes

Team Member Name

First

Last

Employee Information

Employee Name(Required)

First

Last

Employee UW Email(Required)

UW email address

Employee Unit(Required)

AP Sub-Units(Required)

ASA Sub-Units(Required)

DCCS Sub-Units(Required)

HSS Sub-Units(Required)

PRES Sub-Units(Required)

Remote Location Changes

Effective Date(Required)

Effective date of remote location change.

Remote Location Change Type(Required)

Temporary

On-going

Proposed End Date(Required)

End date of remote location change

Ongoing telework agreements still require a review by the supervisor on at least an annual basis. This review is typically completed during the annual performance evaluation process.

Location(Required)

State

There are tax, payroll, and benefits impacts for UW employees working outside of the State of Washington. Please confirm that your employee has reviewed the UWHR out-of-state work policy they have full awareness of impacts and considerations when working outside of WA state.

Tele-work Agreement Upload(Required)

Hybrid tele-work agreements must be signed by the unit executive head or their designee. 100% remote tele-work agreements must be signed by the unit executive head (Vice President, Vice Provost, or their designee). Read more and download forms on the UWHR Tele-work Policies & Agreements webpage.

Accepted file types: pdf, doc, docx, Max. file size: 15 MB.