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Applications Access Request Form Template Indoaksara

This form is used to request access to various IT systems and applications. Section 1 collects employee information. Section 2 specifies which systems access is being requested for, such as finance applications, file sharing, or email. The employee and administrator must sign to agree that the access is job-required and will only be used for business purposes. Section 3 is for approval signatures from IT and management.

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imat rohimat
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79 views1 page

Applications Access Request Form Template Indoaksara

This form is used to request access to various IT systems and applications. Section 1 collects employee information. Section 2 specifies which systems access is being requested for, such as finance applications, file sharing, or email. The employee and administrator must sign to agree that the access is job-required and will only be used for business purposes. Section 3 is for approval signatures from IT and management.

Uploaded by

imat rohimat
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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IT Administrative Applications

Access Request Form


Section 1: Employee Information

Please complete this form and return it to the IT Help Desk (Schulz). A confirmation email will be sent to the employee and appropriate administrator upon completion.

Name (First M. Last) Employee ID

Email Address Work Phone

Department Position/Job Function

Section 2: Access Request Information

System(s) you are requesting access:

FinanceApp Client App VPS File Sharing Email Laptop & Device
Finance Application Customer Application Document File Sharing Mail Account Laptop & Device Access

Name (of employee's access ) Employee ID (of employee's access )

Below, list specific access requests: Role(s), Specific Department #(s), Business Units (if applicable), job functions, business justifications, etc.

My signature below certifies that I am being granted access to information system(s) indicated above because it is a requirement to perform the daily operations of my
position. My access levels are being set based on job requirements of my position at INDOAKSARA. I hereby agree to only use the access and information contained within
the system(s) for business purposes only and will not disclose any information to others that are not appropriately authorized.

Signature

My signature below certifies that the above named employee requires access to data in a computer-based information system because such data is relevant and
necessary in the ordinary course of performing his/ her job duties. I understand my obligation to provide training to this employee to ensure that he/ she understands the
state and federal laws and Commpany policies that govern access to and use of information contained in employee and applicant records including data accessible
through computer-based information systems.

Print Name (Appropriate Administrator) Signature Date

Section 3: For Official Use Only

CMS Security Administrator Signature

Chief Information Officer Signature

Commpany Controller, Administration and Finance Signature (Only Required when "Update Access" is Requested to CFS)

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