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Employee Change of IT Access Form

  1. Access Change Type
  2. Start Date or Last day of work

  3. Employee Information
  4. If you do not have a photo available, we will issue a non-photo ID Badge, or take a photo on your behalf.

  5. Clerk Access:

    Please check boxes for any additional access this employee needs

    All Clerk personnel are issued a badge with access to Independence Courthouse & 1840 Simon Kenton Way unless "No Badge Requested" is checked

  6. County Attorney - Child Support

    All County Attorney personnel are issued a badge with access to 1840 Simon Kenton Way.

  7. (Only for employees needing a new ID Badge)
  8. (Only for employees needing a new ID Badge)
  9. Technology Needs
  10. Providing the name of the previous or a similar employee that this new employee will be replacing helps us determine what badge security to provide, what software permissions to assign, and what computer the new employee will be assigned to.

  11. New Employee Needs....
  12. Departing Employee Had...

    Technology Services will contact you to discuss how to handle County issued mobile devices if necessary.

  13. Departing Employee Email

    Technology Services' standard policy for departing employee email accounts:

    • Email address will be deleted on "Effective Change Date", and all email sent to user's email address will be returned undeliverable.
    • Departing employee's email history can be recovered for 2 weeks following "Effective Change Date", and then will no longer be retained

    If you would like to retain the email address or inbox, please select appropriate options below:

  14. Please enter the email address you want user's email forwarded to.

  15. ECC (Dispatch) Access Needs

    Employee will need access to the following:

  16. Please let us know of any other comments or IT considerations regarding employee needs.

  17. Submitter's name, in case there are follow-up questions

  18. Email or Phone Number for follow-up questions
  19. For new employees, information will be sent to the appropriate contact depending on agency.
    • Fiscal Court - HR will be provided a welcome packet with relevant login information for Orientation
    • Sheriff's Office - information will be sent to Jerry Knochelmann and Misty Feigh
    • For all other agencies, information will be sent to the contact listed on this form unless specified otherwise in the "Notes on Employee Needs" field.
  20. Leave This Blank:

  21. This field is not part of the form submission.

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