The FWA Proposal Form is at the heart of the Cancer Center’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 HEREto
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 FWA 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.
Date
Name
Job Title
Department
Date Request Submitted
Manager
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 the Cancer Center'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 Challenges
4. What solution(s) would you propose to overcome each of the
challenges raised in
question 3? Tip
Solutions
5.
What deliverables and measurements (qualitative and quantitative) do
you propose
that you and your manager use to assess your
performance? Tip Deliverables
Measurements
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 resultfrom 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 completed form to Program
Support in HR (Mail stop: MCC-HR)
after a decision is made.
