1. IT Access Request Form
Please email completed form to: itsupport@xxxxxxx.ca
EMPLOYEE INFORMATION
Employee Name: Employee Title:
Location: Date Requested:
ACCESS CHANGES/DATE
New Hire: Effective Date: Department:
Temporary
Effective Date: End Date: Department:
Access :
Terminate
Effective Date:
Access:
Suspend
Effective Date: End Date: Reason:
Access:
REQUIRED ACCESS
Internet: TELUS: Shaw:
E-mail
E-mail: Address: Webmail Address:
Printer Printer IP
Scan to E-mail: Name: Address:
Folder Folder
Scan to Folder: Name: Location:
Printer Printer
Print: Name: Location: USB: Networked:
Smart Phone: Make: Model:
Notes:
© 2009 HIT Business Solutions Inc. version 1.0 1

2. REQUIRED NETWORK ACCESS:
Drive Letter(s): Example: X:
Path: Example: FinanceAccountsPayable
Path:
Path:
Access: Read Read and Write
Notes:
AUTHORIZATION
Approved by:
Signature: Date:
Please email completed form to: itsupport@xxxxxxx.ca
© 2009 HIT Business Solutions Inc. version 1.0 2