Request for Telephone and Computer Services for New Employee

Please provide a contact name if we have questions regarding this request:

Contact Name
Extension

Please indicate if the new employee is: Full-time Part-time  Adjunct  

What is the number of the room where employee will be located?   

Will the current extension in this room be reassigned to this employee or will a new extension be needed?

Reassign the following extension:    Assign new extension

What is the jack reference number located on wall outlet where phone and computer are to be placed?

When is the new service needed? Date:          

Do you want Voice Mail on  telephone? Yes  No

Type of calling: Local  Long distance  Internal calling only 

Is there a computer in office?  Yes  No

If yes, please provide decal number and CNS will rebuild computer for new employee. PC's decal number 

Any additional information you would like us to know:

When form is completely filled in, print it using File, Print off menu bar at top.  The form should then be forwarded to your  department head for signature and mailed to CNS/Telecommunications.

Signature of Department Head:

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