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. Department Information:
28. Position Title*
29. Department*
30. Physical Location*
32. Supervisor Name*
33. Supervisor Phone Number*
34. Department Head Name*
36. Requesting:
38. Request for:*

    1. Desk phone

    1. Cell phone

    1. Door Access

    1. Mobile Device
40. Phone Options*
    -- Select One --NewExistingN/A
41. Phone Number:
42. Desk phone requested*

    Display name if different from name above

44. Network Folders*

    List any an all shared folders the staff member will need. Type in none if not needed.

46. Access type

    1. Read/View Only

    1. Full Access

    1. Temporary Access
48. Software requested*

    1. Adobe
    2. Analytics
    3. ArcGIS

    1. AutoCAD
    2. CivicClerk
    3. CivicHR

    1. CivicRec
    2. H5

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

    Module(s) Requested

53. Analytics

    Module(s) Requested

55. Shared email address requested*

    example: permits@cityofcrestview.org

57. 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
59. 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. 

60. Other:
64. Employee ID number
65. H5 user name
66. Badge number
67. Email Address:
69. Other
71. Completed By

    IT Rep

72. Date
    Date
Leave This Blank:


73. 1. Receive an email copy of this form.
74. Email address

    This field is not part of the form submission.

75. Submit

* indicates a required field