IT New Staff Request Form

1

Name of User* This field is required.

First Name

Last Name

2

Start Date* This field is required.

Date

3

Name of Requester* This field is required.

4

E-mail of Requester* This field is required.

example@example.com

5

Phone Number / ext

6

New user Site and extension number* This field is required.

7

Type of Employment* This field is required.

8

Type of Computer* This field is required.

10

Peripherals Needed (Select all that Apply)

Wireless Mouse

Wireless Keyboard

Monitor

11

Other Software

12

Mapped Drives / Printers Required:* This field is required.

13

Additional Information

14

Date Submitted* This field is required.

Date

15

Date Requested By* This field is required.

Date