Fillable Key Request Form Room Number Number of Keys (Rogers State University)

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Key Request Form Room Number Number of Keys (Rogers State University)

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Key Request Form
Room Number Number of Keys
____________ ______________
____________ ______________
____________ ______________
____________ ______________
Building:
___________________________
___________________________
___________________________
___________________________
Requested by:
________________________________________ ______________
Department Head Date
________________________________________ ______________
Dean Date
Authorized by:
________________________________________ ______________
Vice President or President Direct Report Date
My signature below indicates that I am totally responsible for the key(s) I am receiving.
I agree that no copies will be made and that I will not allow unauthorized persons to
have access to them. Should the key(s) be lost, I agree to immediately contact either
my supervisor, the Physical Plant at 343-7818, or Campus Police at 343-7624.
I understand that I will be required to pay $25.00 for each lost or missing key.
____________
Date
_________________________________________
Received by (Employee):
KEY REQUEST 12/2020 - KK
Please issue the following codes to:
Employee: _________________________________________
Employee ID #: __________________________
Employee Title: __________________________
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Key Request Form Room Number Number of Keys (Rogers State University)

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Completed 9 February 2021

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