2. Please submit this request at least 2 business days before expected action.
4. Department Submitting Request*
5. Person (Supervisors only) Making Request*
7. Phone*
9. Reason for this request*

   1. A New Employee (to the county)
   2. A Transfer Employee (from other county department)
   3. An Employee Exiting County Employment
   4. An Existing Employee Needing Additional System Access or Equipment Changes
11. Default printer (network name)
13. Transferring from what department?
14. Last date at previous department
    Last date at previous department
16. Employee Name*
    (Name must appear exactly as submitted to Payroll)
17. Effective Date*
    Effective Date
19. Employee profiles are built by copying other employee access rights. Please provide a former/existing employee name for this purpose:
21. Requested System Access for employee

    1. AMANDA (Prothonotary)
    2. Dept Call-offs
       (Supv/Payroll entry staff only)
    3. Email
    4. JNET
    5. New World (payroll)

    1. New World (financials)
    2. Onbase
    3. Phone System
    4. Prison Medical

    1. RVI
    2. Sheriff Infocon
    3. Voicemail
    4. Other
23. Explain 'Other' system access
25. Employee County Office Phone
26. Employee County Cell Phone
28. Action for Departing Employee's U: drive:

    1. Move

    1. Delete
29. Action for Departing Employee's previous emails:

    1. Delete

    1. Archive
31. Action for Departing Employee's future emails:

    (forwarded for 1 year only)

    1. Forward

    1. Reject
32. Forward emails to:
34. Equipment Requests: *

    1. Move Equipment

    1. Remove Equipment

    1. Not Applicable
36. Equipment Location: Building
37. Floor
39. Any Additional Equipment Location Notes
41. County ID# will be required for equipment requests. Select all that apply:

    1. CPU/Laptop/WYSE

    1. Printer

    1. Monitor

    1. Other
43. CPU/Laptop/WYSE CID#
44. Printer CID#
45. Monitor CID#
47. Describe Other Equipment, include CID# if applicable
49. Additional Request Notes or Instructions
Leave This Blank:


50. 1. Receive an email copy of this form.
51. Email address

    This field is not part of the form submission.

52. Submit

* indicates a required field