HR IT Support Request Form

HR IT SUPPORT REQUEST FORM

Personal Information

Requester Name:    Employee ID:

Position Information

Reporting Manager:    Manager Email:

IT Request Details

Type of Request (check all that apply):

Hardware   Software   Access/Permissions   Account Reset   Network/Connectivity   Other

Business Justification / Impact:

Location & Device Information

Operating System:    Phone/Extension:

Manager Acknowledgement

Manager Name:    Manager Email:

Manager Approval: Approved    Pending review

Employment History

Employer 1

Title:    Dates Employed:

Employer 2

Title:    Dates Employed:

Education

References (Professional)

Reference 1

Reference 2

Reference 3

Legal Disclosures & Policies

At-Will Employment: I understand that my employment status is governed by the employer's at-will employment policy, and submission of this request does not alter the at-will relationship between employer and employee.

Equal Opportunity: This organization provides equal employment opportunity and makes employment-related decisions without regard to unlawful classifications.

Device and Data Access: I authorize the organization's IT staff to inspect, access, and, where necessary, image or remove data from the devices listed on this form for the purposes of diagnosis, remediation, compliance, or security. Such access will be conducted in a manner intended to preserve confidentiality of personal information to the extent practicable. I understand that IT access may reveal personal or work-related information and that any personal data discovered during lawful troubleshooting is not the basis for adverse employment action unless otherwise permitted by policy or law.

False Statements: I certify that the information provided on this form is true and complete to the best of my knowledge. I acknowledge that falsification, omission or misrepresentation of information may result in disciplinary action, up to and including termination.

Authorization and Certifications

By checking the boxes below and signing, I authorize the organization to take the specified actions and to contact prior employers or references as necessary to validate employment history relevant to this request and to perform background or security checks where required by policy.

I authorize contact with previous employers and references listed above for verification purposes.
I consent to a background or security check if required to obtain requested access or privileges.
I authorize IT to access and, if necessary, image or remove device data as described above.

A copy of this completed form will be retained in HR and IT records for audit and compliance purposes. Access to records will be governed by applicable policy and law.

Applicant Certification

I certify under penalty of disciplinary action that I have read and understand the statements in this form and that the information provided is accurate. I further acknowledge that system access granted in response to this request is subject to applicable policies, and that misuse or unauthorized disclosure of confidential information may result in disciplinary measures.

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