Form Center

Employee Access Form

2. Network Access Form

   Please complete the form in its entirety.

4. Employee Information
6. Start Date*
   Start Date
7. Type*

   1. New Hire
   2. Change/Add
8. Employee Type*

   1. General Staff
   2. Police

   1. Contractor
   2. Intern
10. Employee First Name *
11. Employee Middle Inital*
12. Employee Last Name*
14. Date of Birth
    Date of Birth
15. SSN
16. Sex
    -- Select One --MaleFemale
17. Race
19. Address

    Full street address

20. Personal phone number
21. Ethnicity
23. Driver's License Number
24. DL expiration
    DL expiration
26. Position Title*
27. Department*
28. Physical Location*
30. Supervisor Name*
31. Supervisor Phone Number
32. Department Head Name*
34. Replacing whom:*
36. Request for:

    1. Email address

    1. Desk phone

    1. Cell phone
37. Phone Options
    -- Select One --NewExisting
39. Phone Number:
41. Number of networked drives requested

    1. 1

    1. 2
43. Network Drive*

    Option 1

44. Network Drive

    Option 2

46. Access type*

    1. Read/View Only

    1. Full Access

    1. Temporary Access
48. Desk phone requested*

    Display name

49. Shared email address requested*

    example: permits@cityofcrestview.org

51. Printer requested

    1. City Hall Admin Hallway
    2. Accounts Payable
    3. Utility Billing
    4. Permitting

    1. Community Development Services
    2. Public Services- Upstairs
    3. Public Services - Downstairs
    4. Community Center

    1. Twin Hills Gym
    2. Fire Station 1
    3. Police
53. Software requested*

    1. Adobe
    2. Analytics
    3. ArcGIS

    1. AutoCAD
    2. CivicClerk
    3. CivicHR

    1. CivicRec
    2. H5

    1. Office 365
    2. TimeclockPlus Manager
55. Office 365*
    -- Select One --Web-based licenseN/ADesktop license
56. Adobe*
    -- Select One --Read/view onlyN/AEdit/Create
57. H5*

    Module(s) Requested

58. Analytics

    Module(s) Requested

60. Door Group:*
    -- Select One --CDSCity HallCommunity CenterFinanceFire AdminFire DeptPark & RecPublic ServicesVisitorOther

    If requesting access to secured areas is needed. HR or Dept Head approval will be required prior to access being  granted. 

61. Other:
62. Employee Picture
66. Employee ID number
67. H5 user name
68. Badge number
69. Email Address:
71. Other
73. Completed By

    IT Rep

74. Date
    Date
Leave This Blank:


75. 1. Receive an email copy of this form.
76. Email address

    This field is not part of the form submission.

77. Submit

* indicates a required field