Intermittent/Situational Telework Request

Montgomery County Fire & Rescue Service

Montgomery County, MD
Intermittent/Situational Telework Request

Division of Human Resources
Requested By
Employee's Name*

First NameLast Name
Employee's Email*
example@example.com
Employee's Supervisor
Supervisor's Name*

First NameLast Name
Supervisor's Email*
example@example.com
Telework Details
Pay Period*
Date Start*

MonthDayYear
Date
Date End*

MonthDayYear
Date
Total Hours*
Reason, Work Location, and Justification*
Please read the statement below and check the box to acknowledge.*

I acknowledge that I have a valid Telework Agreement for Intermittent/Situational Telework for the current fiscal year

Montgomery County Fire & Rescue Service