FWA Guidelines

FWA Proposal Form

The FWA Proposal Form is at the heart of Our Company’s Proposal and Review Process. It is to be completed for new participant arrangements and schedule modifications made to those arrangements. However, if your request is being made because of your own medical condition or that of a family member as defined under the Family and Medical Leave Act (FMLA) or Americans with Disabilities Act (ADA), consult with your Human Resources representative. This form is a tool to help you think through ways to do your job more flexibly and efficiently.

CLICK HERE to complete the Microsoft Word version of the form. This version can be saved and submitted later as an e-mail attachment. PLEASE USE THIS MICROSOFT WORD VERSION TO COMPLETE AND SUBMIT YOUR FORMAL PROPOSAL.

The Proposal Form below is a visual worksheet only and cannot be saved or submitted electronically. Click on "Tip" after questions 1-7 for help in developing answers for those questions. Click Here for a printer-friendly set of tips for both managers and employees on how to best use the form.

Name
Job Title
Department
Date Request Submitted to Manager
Manager

FWA Requested

FlexTime Part-Time Compressed Workweek
Job Sharing Telecommuting Remote Work
Combination/Other (Please Specify)

Describe your current schedule and your proposed schedule:

Days/Hours	Current Schedule		Proposed FWA
	On-Site	Off-Site	On-Site	Off-Site
Sunday
Monday
Tuesday
Wednesday
Thursday
Friday
Saturday
Total Hours

1. How might this proposed arrangement allow you to maintain or improve your individual
     performance? Tip

2. How might this proposed arrangement add value to Our Company's work? Tip

3. What challenges could the proposed arrangement raise with your a) manager b) team or
     coworkers c) internal customers and d) external customers? Tip

4. What solution(s) would you propose to overcome each of the challenges raised in
     question 3? Tip

5. What deliverables and measurements (qualitative and quantitative) do you propose
     that you and your manager use to assess your performance? Tip

6. What review process do you propose that you and your manager use to
     constructively monitor and improve your FWA? Tip

7. What would be one or more warning signs that this arrangement isn't working? Tip

8. Describe any additional equipment/expense that the FWA might require
     (if applicable).

9. Detail any short or long-term cost savings that might result from your new FWA to
     offset any expenses mentioned in question 8.

Manager Review

Proposed FWA is: ___ Approved ___ Declined ___ Modify and Resubmit

Effective date of FWA:  Beginning: _______________

Ending: ________________ (If option is time limited)

Reassessment date: ________________

(All FWAs will be reviewed after 90 days and on a periodic basis.)

I understand that approval of this proposal does not constitute and will not be construed as a contract of employment. The company’s employment relationships are “at will,” meaning that the employee is free to resign at any time and the company may terminate the employment relationship at any time as well.

Employee: Please forward a copy of this form to your Human Resources representative after a decision is made.