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2. Note:

   Complete information for the user you are requesting access for. If you need help with technical details on this form, please contact Gabriel Valenzuela at (520)432-8326.

   Please submit one week prior to hire date.

4. First Name*
5. Middle Initial
6. Last Name*
8. Title*
9. Department*
11. Who will this employee report to?*
12. Employee Start Date*
13. Profile to Model (current user)*
15. Employee's Primary Work Location*
    -- Select One --BensonBisbeeDouglasElfridaHuachuca CitySierra VistaTombstone (TMO)Willcox
16. Additional Location Details (Building A, B, etc)*
18. Accounts

    1. Email
    2. Spillman / VPN
    3. VPN - remote access
19. Printer Access

    List printers user will need access to,

20. Additional Printer Options

    1. Scan to Email
    2. Requires Specialty Code
22. Office Phone*

    1. Desk Phone with Voicemail
    2. Desk Phone without Voicemail
    3. No Phone/Extension Needed
23. Which extension will be assigned?

    If you need a new extension please state "new".

24. Cellphone*

    1. Yes
    2. No

    Department is responsible for cost.
    Call (520)432-8308 for additional info.

26. Computer Hardware Needed*

    1. Laptop Only
    2. Laptop with complete set up (docking station, monitors, mouse, keyboard)
    3. Desktop Computer
    4. None
28. Network Shared Drives and Folders
30. Distribution Lists
32. Additional Special Instructions
34. Specialty Forms/Access Request

    Please complete the following forms if requesting access for the applications listed. (forms will open in a new window so that you can complete this submission)

    For building door access requests please complete this form

    For New World access please complete this form

    For TROCS access please complete this form

    For ADP Manager or Practitioner access please complete this form

38. Requesting Party Full Name*
40. Contact Phone Number*
41. Email*
Leave This Blank:


43. 1. Receive an email copy of this form.
44. Email address

    This field is not part of the form submission.

45. Submit

* indicates a required field