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Employee Change of IT Access Form

  1. Access Change Type
  2. Start Date or Last day of work

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

  5. Clerk Access:

    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

  6. Sheriff ID Badge Access:

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

  7. CareHere Lab Pickup
  8. County Attorney - Child Support

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

  9. (Only for employees needing a new ID Badge)
  10. (Only for employees needing a new ID Badge)
  11. Technology Needs
  12. 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.

  13. New Employee Needs....
  14. Departing Employee Had...

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

  15. ECC Access Needs

    Employee will need access to the following:

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

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

  18. Email or Phone Number for follow-up questions
  19. Leave This Blank:

  20. This field is not part of the form submission.