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User Request Form

The document is a user request form for new, changed, or deleted user access within an organization. It includes sections for employee details, hardware and software requirements, network access, and distribution groups, along with an approval matrix requiring signatures from HR and the CEO. The form is intended to be signed by a manager or head of department to initiate the request process.

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Indra Adam
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59 views2 pages

User Request Form

The document is a user request form for new, changed, or deleted user access within an organization. It includes sections for employee details, hardware and software requirements, network access, and distribution groups, along with an approval matrix requiring signatures from HR and the CEO. The form is intended to be signed by a manager or head of department to initiate the request process.

Uploaded by

Indra Adam
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd

USER REQUEST FORM

New User Change Existing Delete Existing

Employee Number: -

Surname: Pesik First Name: Novaldi Juan Filemon

Department: Operation Location: BSF

Position: HSE Officer Reports to: Indra Adam

Commencement Date:

Name of employee with the same/similar access rights:


Hardware Requirements (tick all that apply)
Computer Phone Camera Additional
Desktop PC Desktop Phone Digital Camera
Docking Station
Laptop Mobile Phone Video Camera
Additional Monitor
Tablet Tough Phone Printer/Dot Matrix
Serial Port
Other: ________________________________________________________________

Email:

Network Access (tick all that apply)


Remote Access (VPN)

Server Folders Access (tick all that apply)


Finance Human Resources & General Affairs
IT Operation
Sales & Marketing HSE & Facilities
Management Legal
Supply Chain

Distribution Groups (tick all that apply)


Finance & Accounting
Sales & Marketing
Purchasing
Operation

Specific Distribution Groups:


USER REQUEST FORM (part 2)

Software Requirements (tick all that apply)


Microsoft Visio Microsoft Project E-Sales
MYOB Krishand FleetMEX

New Software Requirements (tick all that apply)


Other: ___________________________________________________
Price: ___________________________
Purpose: _______________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Approval Matrix

Need HR Approval:
- New User
- Change of Server Folder Access
- Change of Email Address
- Change of Distribution Group

Need CEO Approval:


All Kind of Requests.

Instructions: A Manager or Head Department must sign this form as requester for their employee.

Head Department:

Signature: ____________________ Name: Noviansyah Siregar Date: ___________

HR:

Signature: ____________________ Name: Chintia Puspitaningsi Date: ___________

CEO:

Signature: ____________________ Name: James Ullathorne Date: ___________

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