City of Royal Oak, MI

support@romi.gov

203 S Troy St, Royal Oak, MI, 48067, US

City of Royal Oak - Information Technology

Please use Google Chrome Or Microsoft Edge to fill out this form

NETWORK ACCESS or CHANGE REQUEST

Type of Request

Department

Requested By

For New Employee's a Network Logon Name and Email Address will be assigned by I.T.

Employee's Position Title

Employee's Network Logon Name

Employee Number (For Timesheets Entry)

Full/Part Time

Full Time

Part Time

Date The Employee Starts

New PC Required?

Yes

Software Required

Adobe Reader

Adobe Acrobat DC

BS&A (choose BS&A modules below)

Internet

Microsoft Office

eScribe

Building Alarm Code Required?

Yes

Door Access Card Required?

Yes

Copy door access from?

Desk Phone Required?

Yes

Desk phone extension:

Assign new extension

Use existing extension (enter extension number below)

Existing Extension

Cell Phone Required?

Yes

Type of Cell Phone

iPhone

Flip Phone

Copy Network Access From Which Existing Employee

Date Change Should be Effective

Change Requested

Date of Termination

Reason for Delete

Retirement

Termination

Quit

Job Eliminated

Retain Email?

Yes

Give access to retained Email to what existing employee?

Special Instructions

Has the employee/contractor read and signed the Computer Security and Usage Policy

Yes

Is this user a police department or court employee?

Yes

Has the employee read and signed the Acceptable Use Policy?

Yes

Sign Here

First Name

Last Name

Choose how to sign

Draw Type

I agree to electronically sign and to create a legally binding contract between the other party and myself, or the entity I am authorized to represent.

Receipt

You will be provided with a Receipt upon submission.