Departmental Affiliates, Vendors and Subcontractors
Card Access Request Agreement
To enhance the safety and security of Northern Arizona University’s residential communities, all campus Residence Halls with a common entrance(s) are locked 24 hours daily, 7 days a week. Access to NAU’s residence halls is by Proximity Identification Card and is limited to current residents and departmental affiliates who have been approved by Housing and Residence Life. Prox ID cards are available to individuals, not companies or entities, and can be obtained at the NAU JacksCard Office, located in the University Union, at a cost of $25.00 per card.
Request for University Affiliate Status as a Vendor for Residence Life must be requested prior to or simultaneously with this form.
Request Date:
Requester Information
Name: Phone:
NAU ID Number: Email Address:
Name of supervisor (must be full-time NAU employee): Supervisor’s email:
Date background check completed (required of all NAU staff members):
If background check not complete, please explain why this requirement should be waived:
Department/Company/Organization
Name:
Mailing Address:
Phone Number:
Building Access Request (please be specific)
Halls/Buildings:
Doors:
Days and Times:
Justification for access to the desired buildings:
Student Staff Member access (please be specific)
Note: Student staff access automatically expires on the last day of the semester. Student staff access will be renewed for the specified semesters. If uninterrupted access is required, please provide justification below.
Student staff member requires access for the following semesters: Fall: Spring: Summer:
If access should expire prior to end date of the semester, please provide date to expire access:
If access should be retained across semesters, please provide justification for uninterrupted door access for the student:
Affiliate, Vendor and Subcontractor Access to NAU’s Residence Halls is limited to Main Entrances only. A list of main entrance locations and Residence Hall Desk Hours is available upon request.
Terms of Door Access to Departmental Affiliates:
1. Prox cards are to be used only by the individual to whom they are issued. Lost or stolen Prox cards must be reported immediately to the JacksCard Office and are replaced at the expense of the card holder.
2. Prox cards are to be used for access to NAU’s Residence Halls solely for the purpose stated above.
3. Departmental Affiliates who are issued Prox Card Access to buildings are not to permit access by any other individual on their card.
4. Prox card holders are advised that they are subject to videotaping each and every time they access a card-controlled door.
5. Requestors who are not NAU Employees or Students must present a current form of photo identification with this application. A copy of this identification will be kept on file with the application.
6. Access to the Residence Halls and buildings is contingent upon the requestor passing a background investigation; the buildings are safety-sensitive areas as described in section 1.085 b7 of the Personnel Policy Manual. If the employee’s latest hire date pre-dates this policy, this is not a requirement.
7. Residence Life will perform a yearly validation and reauthorization of access. Each year, personnel with access will be required to submit a new Access Request Form to Residence Life. If this is not received by the established and communicated date, access will be disabled.
8. Student staff door access is automatically expired on the last day of the spring semester. If the student staff member’s access should expire prior to a semester end date, this information must be communicated via the date to expire door access field.
9. It is the responsibility of each supervisor to inform Residence Life when personnel no longer require door access due to changes in responsibilities or job status. Residence Life requests this be done in advance if possible, but no later than the final day access is needed.
10. NAU ID Card access will be assigned to an individual, and are to be used solely by the individual assigned that card.
11. At no time will an entrance door to any building be blocked open, unlocked, or tampered with in any way that may disallow necessary authentication for entry/re-entry. Failure to adhere to this rule will result in removal of door access.
12. NAU staff members are required to complete Preventing Workplace Harassment training before door access is granted.
13. Prox card access is renewed on an annual basis. Prox card issuance may be revoked for failure to adhere to use guidelines at any time.
I agree to the terms of Door Access and Building Access:
______
Employee Signature Date
Employee has completed Preventing Workplace Harassment training _____ (Supervisor’s initials)
Supervisor’s Name (please print):______
Supervisor’s Signature:
Return Form To: / Alicia Voytek, Director, Housing and Residence LifeBox 6100
Fax: 928.523-5443 - For more information, please call 928.523-3978
Signed form may also be scanned and submitted via email attachment to
Approved By: ______Date: ______
Affiliate form completed / Completed by: / Date:Door access granted / Completed by: / Date:
Supervisor notified / Completed by: / Date: