Flexible Work Plan Request Form

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Flexible Work Plan Request Form

Ithaca College believes in and is committed to the promotion of healthy work/life integration. In support of this commitment, Ithaca College invites employees and supervisors to consider Flexible Work Plans (FWPs) when feasible, to meet individual and business needs while maintaining quality services and productivity.

Flexible Work Plans (FWPs) enhance Ithaca College’s ability to attract and retain the best people. In addition, FWPs typically result in increased productivity, employee engagement, morale, and job satisfaction, and improved health and wellness.

Because services within each department vary, approval is on a case-by-case basis, the number and type of flexible schedules may vary widely depending on the needs of those being served.

Please review the complete Flexible Work Plan policy here.

Employee Information

Name*

First Name

Last Name

Email*

Title*

Department*

Supervisor Name*

First Name

Last Name

Supervisor Email*

Campus Organization*

Work Plan Request

Work Plan Type*

Flex Time Compressed Work Week Hybrid Fully Remote

Proposed Flexible Work Plan Start Date*

If you are re-submitting this form for annual review, please select January 1.

FWPs must make business sense. Approval is based on the type of work needed to be performed, the needs of the college, and employee performance. The supervisor and respective Vice President make the final determination on whether a FWP request will be approved. Ongoing eligibility to maintain a FWP requires there to be no negative change in productivity or level of service provided. Staff members covered by a collective bargaining agreement may have benefits different from those described here and should refer to their current agreement.

Please provide rationale for the Flexible Work Plan request, including how it will support the goals of the College, your department, and yourself.*

Please indicate work days/hours/location for the Flexible Work Plan (i.e. Monday: 8:30-5:00 on campus; Tuesday: 8:30-5:00 remote, etc).*

Other Considerations

Remote and Hybrid Telecommuting Information

Where will the work be completed? *

Address Line 1

Address Line 2

City

State

ZIP Code

Is this address updated in IC HR Cloud?

Click here to review/update your contact information in IC HR Cloud. This includes your address and secondary phone numbers and email addresses.

Do you have reliable internet at your remote location? *

Yes No

How will you ensure your accessibility while working remote?*

How will privacy/security/confidentiality requirements be met (data and equipment)?*

Agreement

This form, or any other written or oral information contrary to it, does not create or imply an employment contract, contractual rights or any entitlements between the employee and the College. The College reserves the right to amend this document at any time.

By signing this agreement, the employee hereby agrees to abide by all College policies, practices, etc. as they normally would on-campus in addition to the security of any College data accessed remotely, data accessed electronically, or hard-copy resources taken from the campus. Additionally, the employee agrees to comply with the provisions set forth in this plan.

Your Name*

First Name

Last Name

Today's Date*

Once you submit this form, it will be sent to your supervisor and then your division leader for review. Upon decision, you will receive a notification via email with the approval status.

Supervisor Approval

This form is used to approve or deny a Flexible Work Plan (FWP). Supervisors and Employees should work in conjunction to create a plan that work for all needs. FWPs may be changed, suspended, or cancelled at any time. FWPs are not a benefit, entitlement, or accommodation; they must make business sense.

This FWP is*

Denied Approved Approved with Modifications (please explain below)

Any Modifications:

Additional Comments:

Approved Start Date:*

Supervisor Signature*

First Name

Last Name

Today's Date*

Vice President Approval

This FWP is*

Denied Approved Approved with Modifications (please explain below)

Additional Comments:

Vice President Signature*

First Name

Last Name

Today's Date*