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2. Access Change Type

   1. New Employee

   1. Departing Employee

   1. Change for Current Employee
3. Effective Change Date*
   Effective Change Date

   Start Date or Last day of work

5. Employee Information
7. First Name*
8. Middle Initial
9. Last Name*
11. Agency*
    -- Select One --Kenton County Fiscal CourtKenton County Emergency Communications CenterKenton County PoliceKenton County PVAKenton County ClerkKenton County SheriffNorthern Kentucky Drug Strike ForceKenton County Detention CenterPlanning & Development Services of Kenton CountyCommonwealth AttorneyCounty AttorneyCareHereOther
12. Primary Work Site*
    -- Select One --County Administration - 1840 Simon Kenton WayAnimal Shelter - 1020 Mary LaidleyDetention Center - 3000 Decker CraneIndependence Courthouse - 5272 MadisonPolice & Dispatch - 11777 MadisonPublic Works - 420 Independence StationOther
14. Job Title
16. Photograph for ID Badge

    If you do not have a photo available, we will issue a non-photo ID Badge, or take a photo on your behalf.

18. Clerk Access:

    1. Badge access to Basement Storage
    2. Ability to lock/unlock Voter Registration Door
    3. Badge access to Bookkeeping Office
    4. County email & login

    Please check boxes for any additional access this employee needs

    All Clerk personnel are issued a badge with access to Independence Courthouse & 1840 Simon Kenton Way unless "No Badge Requested" is checked

20. Sheriff ID Badge Access:

    1. Access to Armory (this will be verified & PIN requested)
    2. Access to Evidence Room (this will be verified & PIN requested)
    3. No badge requested

    All Sheriff personnel are issued a badge with access to Independence Courthouse & 1840 Simon Kenton Way unless "No Badge Requested" is checked

22. CareHere Lab Pickup

    1. Check if this user only needs access for lab pickup
24. County Attorney - Child Support

    1. Check to confirm employee needs access to Child Support offices

    All County Attorney personnel are issued a badge with access to 1840 Simon Kenton Way.

26. Employee Birthday
    Employee Birthday
    (Only for employees needing a new ID Badge)
27. Employee Number
    (Only for employees needing a new ID Badge)
29. Other Agency
31. Technology Needs
33. Name of Previous or Similar Employee

    Providing the name of the previous or a similar employee that this new employee will be replacing helps us determine what badge security to provide, what software permissions to assign, and what computer the new employee will be assigned to.

35. New Employee Needs....

    1. New cell phone number activation
    2. Cell phone number reassigned from former employee to new employee
    3. New mifi account activation
    4. New desk phone activation
36. Departing Employee Had...

    1. County issued cell phone or tablet
    2. County issued Mifi
    3. County issued laptop

    Technology Services will contact you to discuss how to handle County issued mobile devices if necessary.

38. ECC Access Needs

    Employee will need access to the following:

    1. Netmotion

    1. LERMS

    1. Mobile

    1. VPN
40. Badge Number
41. Cell Phone Number
43. If this individual has ever worked at another agency in Kenton County, please list the agency:
45. Notes on Employee Needs

    Please let us know of any other comments or IT considerations regarding employee needs.

47. Your Name

    Submitter's name, in case there are follow-up questions

48. Your Contact Info
    Email or Phone Number for follow-up questions
Leave This Blank:


49. 1. Receive an email copy of this form.
50. Email address

    This field is not part of the form submission.

51. Submit

* indicates a required field