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It also specifies agency rights to change or cancel telework, covers special conditions, and requires acknowledgements on work hours, confidentiality, expenses, data protection, and return of agency property.",{"@graph":14,"@context":72},[15,34,55],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/template/","Template",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/template/forms/","Forms",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/template/telework-schedule-and-acknowledgement-form-template-for-agencies/167229/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/telework-schedule-and-acknowledgement-form-template-for-agencies/167229.png","ImageObject",442,249,{"name":42,"@type":43},"Genevieve","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/vnd.openxmlformats-officedocument.wordprocessingml.document","2026-09-23","2026-08-31",true,{"@type":52,"interactionType":53,"userInteractionCount":26},"InteractionCounter",{"@type":54},"ViewAction",{"@type":56,"mainEntity":57},"FAQPage",[58,64,68],{"name":59,"@type":60,"acceptedAnswer":61},"What private information does the form request and why?","Question",{"text":62,"@type":63},"The form requests address and contact information that may include a home or other nonpublic address. The information is used to determine the telework location and may be used to contact the employee during telework, and it may be shared with designated agency and state stakeholders with a business need.","Answer",{"name":65,"@type":60,"acceptedAnswer":66},"How long is the telework arrangement effective and when is it reviewed?",{"text":67,"@type":63},"The telework arrangement is effective for no more than one year. It is reviewed and may be renewed during the performance review period at management’s sole discretion, and it must be reviewed if job duties, position, or any provisions of the arrangement change.",{"name":69,"@type":60,"acceptedAnswer":70},"What responsibilities must employees follow regarding equipment, supplies, and expenses?",{"text":71,"@type":63},"Employees must obtain, maintain, and protect state equipment and supplies, and return all state-owned items when the arrangement ends. Supplies and purchases require supervisor approval, expenses are reimbursed under applicable agreements and policies, and employees must notify supervisors immediately about equipment malfunctions or connectivity issues.","https://schema.org",{"og:url":32,"og:type":74,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":76,"canonical":32},"index,follow",{"doc_id":78,"site_id":7},167229,1790192122,{"code":4,"msg":81,"data":82},"success",[83,88,93,98,103,108,112,117,122],{"id":84,"doc_module":22,"doc_module_name":25,"category_name":85,"show_sort_weight":86,"slug":87},11,"Presentations",90,"presentations",{"id":89,"doc_module":22,"doc_module_name":25,"category_name":90,"show_sort_weight":91,"slug":92},12,"Resumes",80,"resumes",{"id":94,"doc_module":22,"doc_module_name":25,"category_name":95,"show_sort_weight":96,"slug":97},14,"Invoices",70,"invoices",{"id":99,"doc_module":22,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},15,"Posters",60,"posters",{"id":104,"doc_module":22,"doc_module_name":25,"category_name":105,"show_sort_weight":106,"slug":107},16,"Social Media",50,"social-media",{"id":109,"doc_module":22,"doc_module_name":25,"category_name":29,"show_sort_weight":110,"slug":111},17,40,"forms",{"id":113,"doc_module":22,"doc_module_name":25,"category_name":114,"show_sort_weight":115,"slug":116},18,"Letters",30,"letters",{"id":118,"doc_module":22,"doc_module_name":25,"category_name":119,"show_sort_weight":120,"slug":121},21,"Paper Templates",5,"papers-templates",{"id":123,"doc_module":22,"doc_module_name":25,"category_name":124,"show_sort_weight":4,"slug":125},158,"General","general-158",{"code":4,"msg":81,"data":127},{"doc_id":78,"user_id":128,"nickname":42,"user_avatar":129,"doc_module":22,"category_id":109,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":26,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":120,"language":135,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":12,"update_tm":139,"read_time":26},1374391974585,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Telework Schedule and Acknowledgement Form Template for Agencies\nAgencies should customize, brand, and make this form accessible before using.\nTelework Schedule and Acknowledgement\nNotice of Intent to Collect Private Information: This Telework Schedule and Acknowledgement requests you to provide address and contact information that may be your home or other nonpublic address and contact information.  We are requesting this information for the purpose of determining a telework location.  The information also may be used to contact you during telework.   You may refuse to provide the requested information, however if you refuse to supply the information, you will be ineligible for telework.  The requested information may be shared with agency human resources staff, agency executive leadership, agency safety staff, agency supervisors and other agency employees with a business need to access the data, MNIT Services staff, Minnesota Department of Administration, Minnesota Management and Budget, and others as required by court order or as authorized by law.\nTELEWORK LOCATION\nEmployee’s Home\nOther Location: \u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f\u001f________________________________________________________________________\nEQUIPMENT/SUPPLIES\nYou are responsible for obtaining, maintaining, and protecting all state equipment and supplies for use during telework. You must follow normal supply procurement and expense reimbursement procedures for obtaining supplies (e.g. supervisor approval). All state-owned equipment and supplies must be returned when the telework arrangement ends.\nCOMMUNICATION/AVAILABILITY\nTeleworking employees are responsible for attending all required meetings, unless their supervisor approves otherwise.  They must also be available and accessible during the telework schedule for customers, co-workers, and supervisors/managers.\nREVIEW/RENEWAL\nThe employee’s telework arrangement is effective for no more than one year.  It must be reviewed and may be renewed at management’s sole discretion during the employee performance review period.  If the telework arrangement is renewed, the employee must sign a new Telework Schedule and Acknowledgment form.  The telework arrangement also must be reviewed if any of the following occur: 1) a permanent change in employee job duties; 2) a change in positions; or 3) a change in any of the provisions of the telework arrangement.\nCHANGE/CANCELLATION\nThis telework arrangement can be changed or cancelled by the agency at-will, at any time, with or without cause.\nSPECIAL CONDITIONS\n(List any additional instructions, conditions, restrictions, or exceptions relating to this telework arrangement.)\nACKNOWLEDGEMENTS\nI understand, acknowledge and agree to the following:\nTelework is a management tool to be used at the sole discretion of the agency. As such, my telework arrangement may be changed or cancelled at any time, with or without cause, at the agency’s sole discretion.\nTelework hours are regular work hours and I may not use telework hours to perform personal activities. Just as with regular work hours, teleworkers are expected to follow agency vacation and sick leave policies and procedures to request time off from telework to engage in non-work activities.  However, employees may telework even if their dependents or an individual they are caring for is present in the telework location so long as the employee is actually performing their job duties and working their normal schedule or flexing their time as approved by their supervisor.\nI cannot conduct personal business during telework hours.\nMy work duties and responsibilities are not altered by teleworking, and I am responsible for meeting performance expectations and standards.\nMy salary and benefits are not altered by teleworking.\nExpenses will be reimbursed according to the applicable collective bargaining agreement or compensation plan, and consistent with applicable agency and statewide policies. I will obtain my supervisor’s approval before making purchases,","cbCaiifFpiVxp9cQ","https://ap.wps.com/l/cbCaiifFpiVxp9cQ","docx",57081,"English","# Telework Schedule and Acknowledgement\n## Notice of Intent to Collect Private Information\n## Telework Location\n## Equipment/Supplies\n## Communication/Availability\n## Review/Renewal\n## Change/Cancellation\n## Special Conditions\n## Acknowledgements","[{\"question\":\"What private information does the form request and why?\",\"answer\":\"The form requests address and contact information that may include a home or other nonpublic address. The information is used to determine the telework location and may be used to contact the employee during telework, and it may be shared with designated agency and state stakeholders with a business need.\"},{\"question\":\"How long is the telework arrangement effective and when is it reviewed?\",\"answer\":\"The telework arrangement is effective for no more than one year. It is reviewed and may be renewed during the performance review period at management’s sole discretion, and it must be reviewed if job duties, position, or any provisions of the arrangement change.\"},{\"question\":\"What responsibilities must employees follow regarding equipment, supplies, and expenses?\",\"answer\":\"Employees must obtain, maintain, and protect state equipment and supplies, and return all state-owned items when the arrangement ends. Supplies and purchases require supervisor approval, expenses are reimbursed under applicable agreements and policies, and employees must notify supervisors immediately about equipment malfunctions or connectivity issues.\"}]","Telework Schedule and Acknowledgement Form Template for Agencies | DOCX",1788210525]