NEW
MEXICO
TECH
SCIENCE • ENGINEERING • RESEARCH UNIVERSITY
o Visiting Student
or
Scientist
KEY(S) APPLICATION
Department/Division
Phone#
Account
Number
AUTHORIZATION SIGNATURES
Supervisor
Date
Department/Division
Head
Receipt
Number
0 Employee
0 Student
Name
.
+--1--
1H-l-m-1-l---1--m1-m1---I--
-
0 New
D Broken
Requestor
$
Amount
Social Security #/ID #
0 Replacement
D Lost
Date
Deposit
of
$5.-00
per
key is
required
except
for
pern1anent
regular
employees
ISSUE
OF
KEY(S)
The
following is a list
ofkey(s)
required for use during the period
of
employment
or
during the priod
of
educational endeavor.
Only one key
per
person allowed for the same door.
Departments complete
Building
&
Room
only
Building
Room#
Code#
For
Business Office
use
only
Key#
It
is
requested that you agree not to loan the keys to unauthorized individuals, nor duplicate any
of
them. Moreover,
it is requested that loss
of
any key, or keys, be reported to the Department/Division Head, as soon as loss occurs.
By signing the key form and accepting the key(s), it
is
understood that upon leaving campus for an extended period,
the key(s) must be returned. It
is
also understood that proper clearance, which includes returning issued
key(~),
is re-
quired before final paycheck, grades, or diploma will be issued.
Date
of
Issue Signature
Issued
by
RETURN
OF
KEY(S)
Date
of
Return Received
by
Department/Division - Copy
-------------·"
________
!.,
-----
Name
EMPLOYEE ID #, 900# OR DL #
BY SIGNING THIS KEY FORM AND ACCEPTING THE KEY(S), IT IS UNDERSTOOD THAT UPON LEAVEING
NEW MEXICO TECH, ALL KEYS MUST BE RETURNED. IT IS ALSO UNDERSTOOD THAT PROPER CHECK
OUT PAPERWOR AND THE RETURNING OF ISSUED KEYS IS REQUIRED BEFORE YOUR FINAL PAYCHECK,
GRADES, OR DIPLOMA WILL BE ISSUED.
IT IS REQUIRED THAT YOU AGREE NOT TO LOAN THESE KEYS TO ANY UNAUTHORIZED INDIVIDUALS,
NOR DUPLICATE THEM. MOREOVER, IT IS REQIRED THAT THE LOSS OF ANY KEY(S) BE REPORTED
IMMEDIATELY TO YOUR DEPARTMENT HEAD AND THE KEY CONTROL OFFICE.
PHONE #
DEPARTMENT HEAD OR DESIGNEE
NEW
REPLACEMENT
BROKEN
LOST
KEY APPLICATION FORM
KEYS ISSUED: A $5 DEPOSIT PER KEY IS REQUIRED. FULL TIME REGULAR EMPLOYEES ARE EXEMPT
BUILDING
DATE RETURNED
DATE OF ISSUE
ISSUED BY
RECEIVED BY
DATE OF RETURN
SIGNATURE OF RECIPIENT
DEPARTMENT
VISITOR
STAFF
STUDENT
ROOM #
KEY WAY
KEY CODE
ACCOUNT NUMBER
DATE
SUPERVISOR OR DESIGNEE
click to sign
signature
click to edit
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