USER INFORMATION

Last Name: First Name:
Email Address: ID Number:
Department Name: Job Title:
Effective Start Date: Termination/Expiry Date:

The Systems Officer should be advised if the Termination/Expiry Date has changed; failure to do so will affect the user’s access to the PeopleSoft HRMS system.

 

ACCESS INFORMATION

Please list the department number or range of numbers the user should access:

Security Role(s)/Navigation(s) to be assigned:

 

Justification for Access/Comments:

CONTROL INFORMATION
 

Authorized by: