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2. Please Check One*

   1. Employee

   1. Consultant/Intern/Contractor
3. Start Date*
   Start Date
5. Types of Request*

   1. Add

   1. Remove

   1. Change/Update
6. End Date
   End Date
8. Section 1:

   Must be completed in full or form will be returned to the originator.

10. First Name*
11. Last Name*
12. Middle Name
13. Is this a new position?

    1. Yes
    2. No
15. Department*
16. Job Title*
17. If this is a transfer, what department are they transferring from?
19. Is this employee a rehire?*

    1. Yes
    2. No
20. Does phone ext. need to be renamed?*

    1. Yes
    2. No
    3. Not applicable
21. Ext:
23. Section 2:

    Computer service required. Please check/complete the appropriate requests. 

25. Account Service*

    1. Newtowk Account
    2. E-Mail Account
    3. Munis
    4. Town Issued Phone
    5. Website Permissions
    6. VPN Access
    7. Unnecessary
    8. Other
26. Computer Equipment*

    1. Desktop
    2. Laptop
    3. Monitor
    4. Keyboard/Mouse
    5. Unnecessary
    6. Other
27. Network Folder Access:

    1. Read Only Permission
    2. Read/Write Permission
29. Account Service - Other
30. Computer Equipment - Other
32. Mirror Previous Employee?*

    1. Yes
    2. No
33. Name:
35. Notes:
39. Department Head:
41. Manager Signature*
42. Date:*
    Date:
Leave This Blank:


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

    This field is not part of the form submission.

46. Submit

* indicates a required field