County of Wayne

paperless@waynegov.com

224 E Walnut Street, Goldsboro, NC, 27530, US

Employee Change Form for Network Access

Track-It work order number

Today's Date

Type of Change

Department

Effective Date

Employee Title

Goes by (If Different)

Who does this employee replace?

Does Employee Need Email?

Yes

Does Employee need access to GEMS?

Yes

Work Phone (extension)

Building

Room Number

Unit

Does this employee need a Pistol Password?

Last 4 Social

Date of Birth

County Cell Phone Number:

For 911 Only: Employee Status

Full Time

Part time

For EMS Only: Employee Status

Full Time

Part time

Does the Office above have the office equipment needed?

Yes

Please list office equipment needed

Does the Office above have the computer equipment needed?

Yes

Please list what computer equipment is needed:

Employee's Supervisor

Submitter's Email