Instructions: Complete below form upon acceptance of the position by the candidate or approved agreement with a consultant, contractor, temp, or intern. Fill out and print all pages of the form. Give completed and signed form to below contact at least 3 business days prior to the start date (add 1-2 business days lead time if around a major holiday). Send form to sr@centrexit.com, with the subject “New User Request.” The PDF copy shall be stored in the designated folder on the network drive. Hardcopies shall be stored in the User’s HR file.

Name of person completing this form:

Date:

New User Information

First Name:

Last Name:

Job Title:

Start Date:

Department:

Employee Type

☐ Full-Time     ☐ Part-Time/Temp/Intern         ☐ Consultant/Contractor

Dept. Mngr. Approval

Name:

Signature:

Date:

Location:

Please Specify:

☐ Remote/Other (specify):

Hardware

☐ N/A                   ☐ Desktop/Laptop:                         ☐ Other:

IT Use Only

Make:

Model:

Serial #:

MS Office key:

Notes:

Software (choose all that apply)

☐ Microsoft Office365 Suite (Word, Excel, Outlook) ☐ MS Teams (see below for acct setup)

☐ Acrobat Reader ☐ Other (specify):

IT Use Only

CIT Standard Applications:

☒ N-Able Monitoring Agent  ☒ OpenDNS Agent  ☒ Antivirus

Office365 Email Setup

☐ N/A

☐ Yes – Assign email address: FirstName.LastName@phasesci.com

☐ Yes – Assign Other:                                        @phasesci.com

Email Distribution Lists

☐ Phood

☐ Phase USA

☐ New List – Garden Grove

☐ New List – Irvine

File Sharing

☐ Sharepoint

☐ QNAP

☐ DiskStation

Completion

IT Use Only

Name:

Signature:

Date: