APPLICATION FOR ELECTRONIC ACCESS – CARD

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					Buildings & Grounds

APPLICATION FOR ELECTRONIC ACCESS – CARD

  Last Name                                                       First Name


  Staff #                                                         Student #


  Building/Room #                                                 Dept/School/Unit


  Designation/Course                                              Phone # / Ext #

   For all electronic access- CARD inquiries please contact the Buildings and Grounds Service Centre ext: 3217

            This form must be issued without alterations. Please forward this completed form to Buildings and Grounds.
                      When your access card is ready you will be advised in the internal mail.
                       Access cards are to be collected from the Service Centre (front desk) at Building 31.


  CARD Access / Issue

     BLDG #           ROOM #        ACCESS       GROUP ACCESS              TIMES OF ACCESS               ADD       DELETE
                                    DOOR #          LEVEL #




  REASON FOR CARD ISSUE:                       New Card Holder
                                               Amendment to Access – attracts no charges
            This application will incur a charge to the Faculty or Unit of $20.00 per CARD requested.
                      An account number must be supplied for this application to be valid.

              Account Number:                         -              -                        -
  I acknowledge that I have read the conditions on the back of this application form and I agree to abide by these conditions.

  Signature of Applicant __________________________________________________                    Date


  Head of Dept / School / Unit

  I approve the request for electronic access card to the above applicant and agree to the charges.


  Name                                         Signed     __________________________              Date

                   PLEASE TURN OVER AND SIGN YOUR ACKNOWLEDGEMENT OF THE CONDITIONS




 B&G-SC-FRM-002                                Card_Application 2009 Aug                                            Page 1 of 2
     Conditions
 Applicants must read these conditions and sign the application form acknowledging
 agreement to these conditions.

 •   The CARD is issued to provide access to the areas approved by the Head of Faculty
     or Unit.

 •   The Applicant accepts full responsibility for the security of the access card and
     agrees not to share or provide access to other persons. These instruments are
     issued for the sole use of the applicant only.

 •   Any misuse of CARDS or breach of the above conditions may result in the applicant's
     access privileges being cancelled and a report of misconduct forwarded to the Head
     of Faculty or Unit, the Security Manager and the Vice Principal (Administration).

 •   Disciplinary action will be instigated for breaches of these conditions.

 •   Applicants should immediately report to Security staff any incidents.

 •   Applicants must advise the Security Manager within twenty four hours of any
     breaches beyond their control.



     Signature of Applicant ______________________________ Date




       Official Use Only
CARD issue approved by

Name                                Signed ___________________________   Date




B&G-SC-FRM-002                     Card_Application 2009 Aug                    Page 2 of 2

				
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Description: APPLICATION FOR ELECTRONIC ACCESS – CARD