Device Management and Access Policy Acknowledgement Form
A form for acknowledging device management and access policy requirements for assigned devices and system access.
Employee and Device Details
Full Name
*
First Name
Last Name
Job Title / Role
*
Department / Team
*
Work Email Address
*
example@example.com
Device Type
*
Please Select
Company Laptop
Desktop
Mobile Phone
Tablet
Other
Device Identifier / Asset Tag
*
Policy Acknowledgement
Acknowledgment
*
I have read, understood, and agree to follow the Device Management and Access Policy.
Acknowledgment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Access and Return Confirmation
Requested Access Level
*
Please Select
Standard User Access
Admin Access
Limited Access
Temporary Access
Offboarding Acknowledgment
*
I confirm that I am responsible for returning the device or ensuring access revocation at offboarding.
Other
Submit
Should be Empty: