Employee Access Card Deactivation Form
Request deactivation of an employee access card. Please complete all required fields. This form is for authorized personnel use only.
Employee Full Name
*
First Name
Last Name
Employee Department
*
Please Select
Human Resources
IT
Finance
Operations
Sales
Other
Employee Position/Title
*
Access Card Type
*
Please Select
Proximity Card
Magnetic Stripe Card
Key Fob
Other
Card Location/Facility
Reason for Deactivation
*
Please Select
Employee Termination
Lost Card
Damaged Card
Transfer/Department Change
Other
Effective Date of Deactivation
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Requestor Name
*
First Name
Last Name
Requestor Email
*
example@example.com
Additional Comments (if any)
Submit
Should be Empty: