Badge Request Form

Employees complete all areas except those labeled “Contractors Only”. Contractors must complete all areas.

Please Print Legibly

First Name / Middle Initial / Last Name / Suffix / Work Force ID
Preferred Name / Citizenship Country / Employer Name (Contractors Only) / Employers Phone # / Work Location
Start Date (month/day/year)
// / End Date (Contractors Only)
/ / Supervisor (Direct Report) / Supervisor Phone #
Type of Access Requested (To be filled out by the sponsor)
General access 24/7 General access business hours only Buildings/areas needing access
Employee Sponsor (Contractors Only)
Printed Name / Sponsors Signature (Contractors Only)
______/ Date

All must provide emergency contact information

Emergency Contact Name / Emergency Contact Relationship / Emergency Contact Phone #
Badge Agreement
Policies regarding the use and possession of CorningIdentification Badges -
  • Wear the identification badge visibly at all times while on Corning Incorporated property.
  • Show the identification badge upon request by security personnel or any Corning person.
  • Report the loss of the access control badge immediately to Security
  • Not allow others to use or duplicate the badge for any reason.
  • Use the badge for entry/exit to all areas secured by a card reader.
  • Do not allow anyone else, whether a Corning employee or not, to enter any access controlled door or area unless they have correctly badged into the area.
  • Do not use Emergency Exit or crash bar doors for exit from a building except in an actual Emergency.
  • I will not use my badge to fraudulently mislead the Access Control System from recording the date and times I have entered or exited Corning facilities.
  • Return the badge to Corning or my contracted agency upon completion of service and/or termination or at any time requested by Corning or my contracted agency.
  • *Any failure to abide by these policies, related to badge usage, can result in immediate revocation of access to Corning facilities and/or appropriate disciplinary action, up to and including termination.
  • *Corning Incorporated reserves the right to limit access to Corning facilities or revoke the use of identification badges at any time with or without cause*

I have read and understand the Corning Badge Agreement above and do agree to adhere to the policies and procedures used in any Corning Incorporated or Corning Incorporated subsidiary facility.
Signature of person to be issued a badge / Date

Instructions:

  1. All areas in the Employee and Emergency Contact areas must be completed.
  2. Corning Incorporated employees have 24/7 access to their home facility and general access to all buildings Monday through Friday from 5AM to 8PM.

If 24/7 access to another building or facility is required, authorization from the facility manager and the contracted employees sponsor is required.

  1. Contracted employees will be restricted to the facilities where they are performing work.
  2. FAX completed form to 607-974-0451 or email to

Corning Restricted

Security is Everyone’s Responsibility

Rev. 9.8.10