Department Network Access Form

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Authorized Requestor's
E-mail Address:
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Last Name:
  
First Name
  
Middle Inital:
  
Preferred Name:
  
Offical job title / function:
  
On site start date:
  
Complete street address:
  
City:
  
State:
  
Zip Code:
  
Phone number with area code:
  
Extension:
  
Location / Facility / District:
  
Supervisor Name:
  
   
Has this person previously worked for the DJJDP?
  
     
Is applicant employed by DJJDP, but taking another position within DJJDP?
  
     
If so what is this person's new offical job title or function?
  
     
If applicant is employed by an agency other than DJJDP, please provide an email address:
  
     
Should this individual be added to DJJDP E-mail distribution lists?
  
   
If yes, on which lists should this individual be placed?
  
Employment Type:
  
     
Request Access To:
  

IMS (RACF ID)*See note below
NCAS (RACF ID)
E-mail Account
Network Account
NC-JOIN with network login access
NC-JOIN (Staff Member lookup only)
Other

   
Additional Comments:
     
Note: If a RACF ID is requested, please contact the ITHelpdesk for the appropriate form that will need to be completed. *If requesting access to IMS, a Social Security Number will be needed. You can provide this information via phone call to the helpdesk.
   
Authorized Requestor's Name, Address, and phone number (with area code) so that we may contact you when this request has been completed:
   
**NOTE: IMS available to HR and Fiscal Staff only. **
If you need to contact the IT Helpdesk, you may:
Call the Helpdesk at (919) 508-8398, or 1-877-309-1989
Or send an email to the ITHelpdesk
   
   
   
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