Authorized Requestor's
E-mail Address:
Last Name:
First Name
Middle Inital:
Termination Date:
Location / Facility / District:
Is applicant employed by DJJDP, but taking another position within DJJDP?
No
Yes
If so, provide the new location of the employee.
Employment Type:
Permanent Employee
Contractural Employee
Temporary/Intern
Non DJJDP Staff
Did Staff member have a RACF ID?
No
Yes
If so, please list:
Did Staff Member have an Operator ID?
No
Yes
If so, please list:
Did Staff Member have an Email Account?
No
Yes
If so, please list:
Did Staff Member have NC-JOIN Access?
No
Yes
If so, please list NCJoin Log in ID (not the password):
Additional Comments:
Authorized Requestor's Name, Address, and phone number (with area code) so that we may contact you when this request has been completed:
