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Work from Home Request Form

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Template

 

 

Employee name:    _____________________      Title:  _____________________

 

Department:         _____________________      Contact number:    _____________________   

 

E-mail:   __________________________       

 

 

  Request Description 

______________________________________

______________________________________

______________________________________

______________________________________

 

  Category

  • Full-Time Employee 

      from:  __________

  • Part-Time Employee

      from  __________ , to  ____________

  • Temporary Employee 

      hours/days: _________ , from  __________  to __________

  • Seasonal Employee  

      hours/days: _________ , from   __________    to __________

  • One time only                

      Date:            _________ 

 

 

Thank you for considering this request, and let me know if you need more details.

 

 

Employee signature:   _____________________  Date:  _____________________ 

 

Approved by:     __________________________ Date:  _____________________ 

 

 

<Signature>

 

 

[Full Name] 

 

 

[Company Name]

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