Surgery IS Incoming/Exiting Employees

Incoming/Exiting Employee Information

Please use this form to notify Surgery IS of all incoming and exiting employees.
- Incoming requests should be submitted at least one month in advance of start date.
- Exiting requests should be submitted as soon as you are notified the employee is leaving.

Items marked with * are required fields

Employee Name*

First Name

Last Name

Division*

This employee is:*

Start or Exit Date*

Position*

Email distribution group?*

Office Location (Building, Room) - Incoming Employees only

Equipment Needed - Incoming Employees Only (Select all that apply)

Desktop - PC Desktop - Mac Laptop - PC Laptop - Mac Tablet - Surface Pro

Other:

Speedtype - Needed only for New Equipment Purchases

Access to which server folders? - Incoming Employees only

Additional Information

Your email address*