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
    2. Cell phone

    1. Door Access

    1. Mobile Device

    1. Network Folder
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
    3. Office 365

    1. TimeclockPlus Manager
    2. Laserfiche
    3. N/A
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. Laserfiche
    -- Select One --ParticpantFull User
56. Access requested:*

    What division access is needed?

58. Shared email address requested

    example: permits@cityofcrestview.org

60. 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
62. Door Group:
    -- Select One --CDSCity HallCommunity CenterFinanceFire AdminFire DeptPark & RecPublic ServicesVisitorOtherN/A

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

63. Other:
67. Employee ID number
68. H5 user name
69. Badge number
70. Email Address:
72. Other
74. Completed By

    IT Rep

75. Date
    Date
Leave This Blank:


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

    This field is not part of the form submission.

78. Submit

* indicates a required field