IT Access Request Form V2

IT ACCESS REQUEST FORM
New Employee Info
Instructions: The supervisor should complete the top portion (under NEW EMPLOYEE INFO) of this form and mark the check boxes for access/equipment needed and then return it to the IT Department. Please allow 2 business days to setup a new user in the system, allow additional time if new equipment must be purchased. Please send IT the original electronic document with the form fields filled out. Do not print or scan. Form will be returned with temporary credentials filled out and any equipment requested.
New Employee Info*
PrefixFirst NameMiddle NameLast Name
Employee start date:*
MonthDayYear
Date
Contact #:*
Format: Country Code-Phone Number
Job Title:*
Supervisor's Name:*
Department:*
Select Head Office:*
Select Office Setting:*
Desk Location:
Example: First Floor, Second Floor, Next to Joe's Desk, etc.

	Access	Deactivated	Returned
Laptop	1	2	3
Surface	4	5	6
PC / Desktop	7	8	9
Desk Phone	10	11	12

	Access	Deactivated
Network/AD User	13	14
Accounting/ERP	15	16
Email/Sharepoint	17	18
Full Adobe Suite	19	20
Amadeus / Sabre / Galileo	21	22

	Phone Number with Ext. / Direct Dial	Date Added	Deactivated	Returned
Cell Phone			23	24
Remote/Desk Phone			25	26

Cell Phone Plan Reimbursement
Allowance Limit Data / Talktime Date Added Start Date End Date
Cell Phone
Building Access
Access Card / Key Access Hours Issued On Deactivated Returned
Security System 27 28 29
Similar To Other User:
Notes / Other Requirements:
Acknowledgement:
I, , understand that I will be receiving company equipment and properties here before listed and hereby acknowledge that I am responsible for the correct use of the properties and equipment provided by the company. Should the employment be terminated by either party, I am responsible for returning all the equipment, properties and tools in proper working conditions, and the failure to do so within company policy/guideline or reasonable timeframe shall allow the company to take corrective action, including but not limited to legal action.
Supervisor's Signature:*
Clear
Employee Signature:*
Clear
Date:*
MonthDayYear
Date
Date:*
MonthDayYear
Date
IMPORTANT:
- All temporary passwords listed above must be changed upon receipt of items
- Quick link for Office 365: https://portal.office.com; username: email(username) / password: email(password)
- Print an electronic copy of this form and send to your Supervisor
Should be Empty:

IT ACCESS REQUEST FORM