Employee IT Separation Request Form

Employee Separation Request Form

*Please contact HR to find out an employee's CWID Number

Employee CWID*

Requestor Information*

First Name

Last Name

Title*

Email*

Phone*

Name of Employee*

First Name

Last Name

Date to Perform Action*

Time to Perform Action*

:

Account/Application/System Access

Disable access to Network/Email Account (@mercy.edu)

Forward Email as requested Forward to

Please provide an Out of Office message for the account being de-activated. Please note this message will be sent for 6 months post account separation.*

Forward Telephone

Disable access to Web Applications/Systems

Yes No

Disable access to ERP Application/Systems

Yes No

Disable access to Higher One CASHNet

Yes No

Disable Access to Slate CRM

Yes No

Would you like to have I.T. send a Return Box and Shipping Label for the remote employees' equipment?

Yes No

Collect Basic Cell Phone/Smartphone from

Collect Laptop From

Equipment Reassigned to

Comments/General Instructions