Employee IT Separation Request Form About Mercy Information Technology Employee IT Separation Request Form More in this Section Information Technology Digital Equity Grant Employee IT Separation Request Form IT Transfer Request Mercy Technology Discounts Accounts and Access About IT Support Helpful Links Telephone Services Applications Mercy Connect FAQs Mercypass Request a Department Email Account Computer Labs How To Tutorials OneDrive Guidelines Mercy Connect Beginner's Guide Desktops Laptops Mobile Mobile Device Security Wireless Network Parents Students Visitors and Guests Instructional Design and Support Software and Hardware Think-Cell Hardware Standards Research Support Teaching Tools IT Student Communication Employee IT Separation Request Please fill in a valid value for all required fields Please ensure all values are in a proper format. Are you sure you want to leave this form and resume later? Are you sure you want to leave this form and resume later? If so, please enter a password below to securely save your form. Save and Resume Later Save and get link You must upload one of the following file types for the selected field: There was an error displaying the form. Please copy and paste the embed code again. Apply Discount You saved with code Submit Form Submitting Validating There was an error initializing the payment processor on this form. Please contact the form owner to correct this issue. Please check the field: Fields 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* https://www.formstack.com/forms/images/2/calendar.png Month Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2018 2019 2020 2021 2022 2023 2024 2025 2026 2027 2028 Time to Perform Action* Hour 01 02 03 04 05 06 07 08 09 10 11 12 Minute : 00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 AM/PM AM PM Account/Application/System Access Disable access to Network/Email Account (@mercy.edu) 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 Comments/General Instructions Previous← Next→ Formstack Online Forms Enter your save and resume password Cancel Confirm