Campus Id And Key Request Form

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Campus ID and Key Request Form
(Form to remain on file at Campus Police)
Supervisor Information:
Supervisor Name
Supervisor Title
Request Date
Reason for Request:
New Employee
Add/Change/Remove Access
Lost Card or Key
ID Owner Information:
Employee Name (Last, First, MI)
Employee ID
Office Phone Number
918
229-391-
Department/Unit
Job Title
Position Type
Full-Time
Part-Time
Temporary
Non-Employee
Gender: M / F
Date of Birth: ____________________
MM/DD/YYYY
ID Card Information:
Add Building Access
Remove Building Access
Reason for Adding Building Access:
Reason for Modifying Building Access:
ADD NEW BUILDING ACCESS
REMOVE BUILDING ACCESS
Date Access Added
Building Name
Building Name
Date Access Removed
Key Request/Returned Information:
New Key(s) Issued
Key(s) Returned
Building Name
Room Number
Date Issued
Date Returned
Verified By
I understand that by signing this request I must adhere to the ABAC ID/Key control policy. Should I lose my ID or key, I
should notify the ABAC Police Key Control Specialist as soon as possible. Persons who lose keys will be assessed $50 to help
offset the cost of re-keying the lock. There is a $25 fee for replacing electronic card keys.
Signatures:
Employee’s Signature
Supervisor’s Signature
Date
Date
Revised 1/7/16

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