BROWN COUNTY TECHNOLOGY SERVICES (BCTS) *DO NOT PRINT*
SYSTEM ACCESS FORM – USER DEPARTURE
Supervisor Instructions:
- Use this form for Employee/LTE/Vendor/Volunteer/Contractor terminations.
- Fill out the form completely, ensuring the correct spelling of the user’s name. If you are unsure of the meaning of any part of this form or need assistance filling it out, please call the Help Desk at 448-4030. Missing or incorrect information will delay processing!
- Type your name in the Supervisor Signature section and fill in the date (do not hand sign the document)
The act of forwarding with your name in the field is an electronic signature.
- Email this form (Do not print it out and mail it)
An employee’s supervisor is legally responsible for authorizing the adding, changing and removal of rights to all accessed information, regardless of who enables the access. This includes access to systems that are controlled by the supervisor’s department.
After Human Resources processes the departure, they will forward the form to Technology Services.
BCTS requires 6 business days upon receipt of this form (minimum) to complete the request.
To be entered by Technology Services: Date Received in TS:
*REQUIRED AUTHORIZATIONS*
HR Authorized eSignature:Date:
Typing your name here and emailing the form is equivalent to a signature
Supervisor eSignature: Date:
Typing your name here and emailing the form is equivalent to a signature
Effective Date: (usually the user’s last day in your department/work unit)
*USER INFORMATION*
User Type:
☐Regular Employee ☐Paid Limited Term Employee ☐ Vendor/Volunteer/Contractor/etc.(non-employee)
Last Name: First Name: Middle Initial:
User ID: Employee ID Number (if employee):
Vendor/company name: Login: ☐ Individual ☐Shared
Check one: ☐ Resignation/Retirement ☐ Involuntary Termination ☐ Vendor/Volunteer/Contractor
☐ Legal Hold Until: (date)
Special Instructions:
*OTHER USER INFORMATION *
Supervisor Name: Supervisor Phone:
Supervisor Email:
** If this Employee used a mobile device/phone with County email access, that access will be terminated. It is the supervisor’s responsibility to retrieve any County owned device/s from the employee. All County owned mobile devices/phones MUST be returned to Technology Services immediately!
** This employee’s U:\ drive data will be moved to the supervisor’s U:\ drive into a folder named for the employee. This will be the only copy of the employee’s U:\ drive data, unless a legal hold was requested.
Forward Office Phone to:
Forward voicemail to:
Change voicemail outgoing message to:
TS will create a standard email out of office message if the user/supervisor has not already created one.
Or,Custom message:
Other Notes:
*APPLICATION ACCESSTO BE REMOVED FOR DEPARTING EMPLOYEE*
Remove access to the following applications:
☐ Industry Weapon
☐ Laserfiche☐
☐ Logos☐
☐ Milestone☐
☐ Internet Website Maintenance☐
☐ Intranet Website Maintenance☐
Notes:
If access removal is needed for Department applications that are not managed by the TS Department, please contact the application administrator for that application. Examples include: Kronos, OMS, RMS, Avatar, eWISACWIS, CARES, KIDS etc.
*AS/400 ACCESS TO BE REMOVED FOR DEPARTING EMPLOYEE*
Remove Access Remove Access
BCLAND – Treasurer☐BCGEN – Sheriff☐
BCLAND – PALS☐BCGEN – Finance ☐
BCLAND – Municipality☐BCGEN – Health☐
BCLAND – Assessor☐
BCGEN – Human Services ☐BCGEN – ☐
Other Notes:
Management, assignment and return of equipment, devices, ID badges, software and other County property is the responsibility of HR and the Department Head. This form is exclusively for Brown County Technology Services account management.
For TS Use Only
Page 1 of 3 Updated December, 2016