Computer Information Services
Department
Today's Date:
EMPLOYEE INQUIRY INFORMATION
Employees Full Name:
Employee #:
Job Title:
Assigned Dept.:
Prior LCC e-mail address:
Phone/Extension:
Office Location
(Building & Rm #)
Supervisor/Director
Signature:
INQUIRY DETAILS
Type of Account Requested: (Check all that apply)
Telephone Support:
Voice Mailbox Reset/Setup
Long Distance Code
PC Network Account
CARS Account
(with completed training)
Start/Hire Date:
This Employee is:
New Hire Current Employee
Transferred Position
Re-Hire (Had previous accounts)
Approval to add new accounts listed above:
Date:
Account Date Enabled Entered by Notes: (module, account name)
Voice Mailbox
Long Distance
Network
E-Mail
CARS Account
Human Resources:
Needs Phone
Student/Employee need account access
I.T. Office use only
Employee Technology Systems account request
Employees Cell #
Print Form
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signature
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