Template: Work From Home Request Form

Employee information

Full name *

Employee ID

Job title *

Department *

Work email *

Phone number

Direct manager name *

Manager email *

Date of request

Employment type

Type of WFH request

📅

One-time

Single day or short period

🔄

Recurring

Specific days each week

🏠

Full-time Remote

100% remote arrangement

🔀

Hybrid

Split office and remote

🏥

Emergency

Medical or urgent personal

✈️

International

Working from abroad

Request dates & schedule

Start date *

End date *

Total WFH days

Proposed working hours

Your timezone

Reason for WFH request *

Projects / tasks you will work on

Employee commitments

Please read each commitment carefully and check to acknowledge before submitting.

I will maintain my regular working hours and be reachable during core hours

Available via Slack, email, and phone during agreed hours

I will attend all scheduled meetings via video call

I have a suitable setup for video conferencing (camera, microphone, quiet space)

I will comply with the company's data security policy at all times

Including VPN usage, device locking, and not sharing access credentials

My remote workspace is safe, private, and suitable for professional work

Free from significant distractions and meets health and safety standards

I will maintain my current level of productivity and meet all deadlines

Remote work does not change my performance expectations or deliverables

I will promptly notify my manager if my remote situation changes

Including connectivity issues, location changes, or personal emergencies

I understand this request is subject to manager approval and may be revoked

WFH approval can be withdrawn based on business needs or policy violations

I will use company-issued devices only for work-related activities

Personal use of company devices is not permitted

Additional notes for manager

Employee declaration

Employee signature

Full name (as signature)

Date

Employee signatureDate

Review your request

WFH Request Summary

Pending Approval

Employee name-

Job title-

Department-

Request type-

Start date-

End date-

WFH days-

Working hours-

Workspace type-

Direct manager-

Commitments agreed-

Reference number-

For manager use — approval section

Manager decision

Approved Approved with conditions Declined

Manager name

Decision date

Manager comments / conditions

Manager signature

HR reference (optional)

Manager signatureDate

Remote Work Setup

Template: Work From Home Request Form

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