Work From Home Request Form Template

Are you planning to work from home? Please fill in this form to apply. We will review your request and discuss with you any further steps or requirements necessary for an approval.
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*
1.
Your basic information:
Name
Name
Employee ID
Employee ID
*
2.
Your email address:
*
3.
What is the reason for requesting to work from home?
*
4.
When would you like to begin working from home?
*
5.
How many days would you like to working from home?
*
6.
Do you have all technical equipment needed to work remotely?
Yes
No
8.
Is there anything specific that you need to best recreate your work environment at home?
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