University of Hawaii
Employee Mobile Device Program
New
Update Termination
Employee Name:
EmpID:
Department:
Job Title:
Eligibility and Justification (Check at least one):
24/7 access employees: Day-to-day job responsibilities require routine response to urgent (immediate action
required) University business at any time of the day or night – e.g., addressing student/lab safety issues,
answering media requests, handling on-call server operations, etc.
Mobile employees: Job requires routine field work and needs to communicate real time with office to give or
receive direction or manage official University social media.
Frequent travelers: Defined as at least 60 travel days per year
Other business cases that meet at least one of the following criteria:
Role requires staff member to routinely respond to urgent (immediate action required) University
business while staff member is away from the office.
Role requires staff member to be routinely available while in remote locations.
Other business case. Please Specify.
on to UOpti tilize:
University-Provided Mobile Device
Mobile Device Allowance ($30)
Effective Start Date:
Effective End Date:
Certification and Signature
• The University provided mobile device or allowance I receive will be primarily for business.
• If the business use is no longer needed, or there is a change or interruption in service of the device, it is my
responsibility to notify my department contact.
• I understand and will protect University business-related data and comply with Executive Policy E2.214,
Institutional Data Classification Categories and Information Security Guidelines, whether on a University-
provided device or on a personal device used for business purposes.
Employee’s Signature: ___________________________
Date: _____________________________
Approval:
Title
Name
Signature Date
Supervisor
Dean or Director
Executive
KFS Account Number to be charged for Allowance: ______________________________
DISB-15
(01/1/2019)
Campus:
Select the option that applies:
Contact Phone #
