Please complete this form and return to Information Technology. The department Supervisor or Dean must sign this form. Allow up to 5 working days (from receipt of form) for processing.
Today’s Date:
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Date to Start Work:
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EMPLOYEE INFORMATION
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Name:
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Title:
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Department:
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Telephone Extension:
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Primary Campus and Rm. No.:
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(Example: SJC, Rm. 223)
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Workstation Number :
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(The No. is on the top right hand corner of the PC i.e. W.S. 124)
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Secondary Campus and Rm. No.
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(Example: MVC, Rm. 500)
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Permanent or Temporary
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Permanent Temporary
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Distribution Group: (Permanent staff)
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Administrator/Mgmt Faculty Classified
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New or Current Employee
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New District Employee Current District Employee
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Current Employees Only
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The employee works for the same department and needs additional access.
The employee transferred from another department and their access needs to be modified as indicated on this request.
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Temporary Employees Only
(Check for additional drives & e-mail)
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(Permanent Employees automatically get e-mail and these drives.)
E-mail F (Personal) J (Department) P drive (Public)
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HARDWARE
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Select a checkbox in each section.
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PC Setup: Existing Computer
Order (Your Dept. pays)
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Printer Setup: Existing Printer
Order (Your Dept. pays)
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Telephone Setup: Existing Phone
Order (Your Dept. Pays)
Only Add to Directory List
Reassign Extension to Employee
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Network Drop Existing Network Drop
Order (Your Dept. pays)
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DATATEL ACCESS
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Complete for Datatel Users Only.
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Provide Datatel Access
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Provide Datatel Test Account
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Module Leader:
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Security Class:
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If temp. enter birthdate:
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SOFTWARE ACCESS
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The standard Network software installations for all employees include: MS Windows XX and MS Office XX (Word, Excel, PowerPoint, Access, Internet Explorer).
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ADDITIONAL SOFTWARE ACCESS:
(Check the appropriate checkbox.)
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Access to the following applications requires an administrative signature from the authorized department, unless your department is the responsible party.
Imaging (Hershey Systems, Inc.) Signature:
(Enrollment Services)
Check “one” checkbox for the type of security required:
Enrollment Services Financial Aid
Counselor Supervisor
Viewer Scanner
Evaluator Viewer
Scanner
Ad Astra Supervisor’s signature is sufficient.
ChildCare NoHo Signature:
(ChildCare)
Galaxy Signature:
(Business Services)
HR Imaging Signature:
(Human Resources)
ID Card System Signature:
(Enrollment Services)
One Source Signature:
(Business Services)
SARS Signature:
(Counseling)
Sirsi Signature:
(Library)
Other:
Signature:
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Comments:
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Supervisor’s Signature:
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Print Name:
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Network ID:
Network Temp. Password:
Network Account Created by:
Date Network Acct. Created:
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Mainframe Logon:
Mainframe Logon Created By:
Date Mainframe Logon Created:
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