Information Technology Exit Form - Guam Waterworks Authority
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Information Technology Division
Office (671) 647-7634 Fax (671) 649-4320
INFORMATION TECHNOLOGY EXIT FORM
Employee Name: _____________________________ Emp. No.: ______________Date:_____________
Position:_________________________________ Department: _________________________________
Supervisor: ___________________________________________________________________________
Last day of work at GWA : _______________________
IT Staff Initial
E-mail
E-mail address: __________________
___________
GWAMAIN User ID: ___________________
___________
VDI
VID Tag #: _________________
___________
JDE
User ID: ___________________
___________
AS400
User ID: ___________________
___________
PayGWA
User ID:___________________
___________
Desktop PC
Tag # _____________________
___________
Laptop
Tag # _____________________
___________
Radio
Iconnect # _________________
___________
Mobile
Mobile # __________________
___________
Handheld
Handheld Tag # __________________
___________
Others
Other equipment assigned: ______________________________
___________
______________________________
___________
Employee Signature: ____________________________________________ Date: __________________
The employee listed above has cleared from Guam Waterworks Authority IT Division and has cleared all
Government of Guam computer equipment and user id(s) in fair and working condition.
____________________________________________________________________________________
Prepared by IT Operator
(Print and Sign)
Date
______________________________________________________________________________________
Authorized IT Division Head
(Print and Sign)
Date
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