Employee Temporary Security Badge

Employee Temporary Security Badge

Badge Details

Badge Number:   Issued:   Expires:

Employee    Contractor    Visitor    Temporary Staff

Personal Information

Date of Birth:   Employee ID (if applicable):

Phone:   Email:

Position Information

Department:   Reporting Manager:

Expected Start Date:   Temporary Assignment Reason:

Employment History

Employer 1

Title:   Dates Employed:

Employer 2

Title:   Dates Employed:

Education

Graduation Date:

Professional References

Reference 1

Phone:   Email:

Reference 2

Phone:   Email:

Reference 3

Phone:   Email:

Security Policies and Acknowledgments

This temporary security badge remains the property of the employer and is issued solely for the purposes and duration set forth on this form. Badge access privileges may be modified or revoked at any time at the discretion of Security. The badge must be worn and visible at all times while on premises and must not be loaned, duplicated, altered, or transferred to another person.

Lost or stolen badges must be reported immediately to Security. Failure to report loss or misuse may result in disciplinary action, revocation of access privileges, and civil or criminal liability. The holder is responsible for charges incurred as a result of breach of security caused by negligence.

The employee/contractor consents to the collection of photograph and identifying information for the sole purpose of identity verification and badge issuance. Such photograph and identifying information will be retained in company records for security and audit purposes and disposed of in accordance with company retention policy.

I authorize the company and its agents to conduct a background check, including employment verification and criminal history, in connection with this badge issuance.

I consent to the taking and use of my photograph for the purpose of issuing a security badge.

Applicant Certification and Consent

I certify that the information provided in this form is accurate and complete to the best of my knowledge. I acknowledge that the temporary badge may be revoked at any time and must be returned immediately upon request or upon termination of access privileges. I authorize the company to contact the employers and references listed on this form to verify the information provided and to obtain any information relevant to my suitability for access to company facilities.

I understand and agree that misuse of the badge, failure to follow security procedures, or providing false information may result in disciplinary action up to and including termination, civil liability, and criminal prosecution.

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