IT Account Policy Acknowledgment Form
Use this form to confirm you have reviewed the organization’s IT account policy and agree to follow the required account security and usage rules.
Employee and Account Details
Full Name
*
First Name
Middle Name
Last Name
Work Email
*
example@example.com
Department
Please Select
Engineering
Information Technology
Human Resources
Finance
Operations
Sales
Marketing
Customer Support
Other
Job Title
Manager Name
Work Location / Office
Please Select
Headquarters
Regional Office
Remote
Hybrid
Other
IT Account Policy Coverage
Account types covered by this acknowledgment
*
Email account
Network login
VPN/remote access
Cloud applications
Shared/admin account
Other organization-provided account
I confirm that I have received and reviewed the IT account policy document or summary
*
Yes
No
Security and Acceptable Use Acknowledgment
I acknowledge and agree to follow the organization’s password requirements
*
Yes, I agree
No, I do not agree
I acknowledge and agree to use multi-factor authentication when required
*
Yes, I agree
No, I do not agree
I acknowledge that account sharing is prohibited
*
Yes, I agree
No, I do not agree
I acknowledge and agree to lock my device or screen when unattended
*
Yes, I agree
No, I do not agree
I acknowledge the acceptable use and access rules I must follow
*
Use systems only for authorized work
Do not access restricted or inappropriate content
Follow remote access and VPN rules when applicable
Report policy violations or suspicious activity
Other
I acknowledge my obligation to protect credentials and access information
*
Do not share access credentials
Store credentials securely
Log out when finished
Use approved access methods only
Other
Incident Reporting and Support
Preferred IT support contact method
*
Email
Phone
Help Desk Portal
In Person
Other
Manager or IT contact name or team
*
I agree to report the following promptly
*
Suspected account compromise
Unauthorized access
Lost or stolen device
Policy violation
Other security concern
Questions or exception request
Final Acknowledgment
Signature
Date Signed
*
-
Month
-
Day
Year
Date
Submit Acknowledgment
Submit Acknowledgment
Should be Empty: