PeopleSoft Information Access Request Form

The University of Southern Mississippi
PeopleSoft Information Access Request Form

To be completed by employee’s supervisor (boxes 1 through 16)

1. Employee Name*:

11. Type of Access*:
New Access
Revising Access
Delete Access

2. Ocean ID*:

3. Empl ID*:

12. Does this person replace an existing one?*
Yes, Who
No

4. SSN (Optional):

5. Title*:

13. Did the employee transfer from another Univeristy department?*
Yes, Dept.

Date

6. Email Address*:

7. Work Phone*:

14a. Is the Citrix client software installed on the employee's PC?*
(This software is needed to access PeopleSoft.)
Yes
No

8. Mailing Address (USM Box)*:

9. Home Department*:

14b. Does this employee currently have an active Citrix account?*
(A Citrix account is needed to access PeopleSoft.)
Yes, Citrix username
No

10. Home Department Account Number*:
Fund_Dept.ID_Program_Project/Grant_Approver|Title:

15. Please specify the duties the user will be required to perform with the module(s). If requesting access to the Financials modules, specify the organization numbers (account numbers) for which you have responsibility?*

16. The employee’s specific access actions (add, update, etc) will be determined upon review of user requirements and in conjunction with the Data Custodian’s recommendation and in consideration of the employee’s role within the University. Access to University information carries with it direct responsibility for the proper use, control, and release of all University data. The employee’s signature below signifies that the employee has read the Information Technology Acceptable Use Policy located at http://www.hr.usm.edu/handbook.shtml and signed the Statement of Understanding and will comply with all University information access and release procedures.

Employee Signature__________________________________ Date______________________

Supervisor Signature_________________________________ Date______________________


PeopleSoft Information Access Request Form (front)	10/31/01

Click this button to display this completed form optimized for printing.
Submit the printed and signed form to Jennifer Spring/Kris Fulton.
(Print an additional copy for your records.)

If you get an error/missing field message, use your browser's BACK button to return to this form.

*indicates required entry

Other Sites of Interest

[Information Access and Security Policy]
http://www.hr.usm.edu/handbook.shtml (not functioning 4/21/10)

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