Key Request Form
Campus Police PO Box 1101 Richlands, VA 24641
Reason:
Supervisor: Date:
Date:
Date:
Date:
Date:
Div.Dept. Head:
VP/President:
Comments:
Rev. 2020-06-22
Requested by:
Employment Status: Full Time
Request Access to (building/room number(s):
Part Time Other
I ____________________ have received the above requested key(s). I understand
that keys issued by the College are not to be copied or loaned. In the event any of the
keys issued to me are lost or stolen, I understand that I am to notify the Campus Police
Department immediately. Upon separation of employment, I understand that all keys
issued to me by the College are to be returned to the Campus Police Department.
All keys issued to the above named person have been returned to the Campus Police Department.
Signature of person receiving key(s)
Signature of Department Ocial
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