BROWN COUNTY TECHNOLOGY SERVICES (BCTS) *DO NOT PRINT*

SYSTEM ACCESS FORM – USER NAME CHANGES

Supervisor Instructions:

  1. Use this form for user name changes only.
  2. Fill out the form completely, ensuring the correct spelling of the user’s new name. If you are unsure of the meaning of any part of this form or need assistance filling it out, please call the Help Desk at 448-4030.Missing or incorrect information will delay processing!
  3. Emails sent to the user’s old email address will automatically be forwarded to the user’s new email for 30 days. After 30 days, thatold email address will be deleted.
  4. Typeyour name in the Supervisor Signature section and fill in the date (do not hand sign the document)

The act of forwarding with your name in the field is an electronic signature.

  1. Email this form (Do not print it out and mail it)

An employee’s supervisor is legally responsible for authorizing the adding, changing and removal of rights to all accessed information, regardless of who enables the access. This includes access to systems that are controlled by the supervisor’s department.

After Human Resources processes the name change, they will eSign and forward the form to Technology Services.

BCTS requires 6 business days upon receipt of this form (minimum) to complete the request.

To be entered by Technology Services: Date Received in TS

*REQUIRED AUTHORIZATIONS*

HR Authorized eSignature:Date:

Typing your name here and emailing the form is equivalent to a signature

Supervisor eSignature: Date:

Typing your name here and emailing the form is equivalent to a signature

Effective Date:

*USER’S CURRENT INFORMATION*

User Type:

☐Regular Employee ☐Paid Limited Term Employee ☐ Vendor/Volunteer/Contractor/etc.(non-employee)

Last Name: First Name: Middle Initial:

User Name (if exists): Employee ID Number (if employee):

Vendor/company name: Login: ☐ Individual ☐Shared

Supervisor: Supervisor Email:

* NAME CHANGE INFORMATION * Please ensure correct spelling! Errors will cause delays.

New Last Name: New First Name: New Middle Initial:

*APPLICATION ACCESSCHANGES REQUIRED*

Updateaccess to the following applications:

☐ Industry Weapon
☐ Laserfiche☐

☐ Logos☐

☐ Milestone☐

☐ Internet Website Maintenance☐

☐ Intranet Website Maintenance☐

Notes:

If access changes are needed for Department applications that are not managed by the TS Department, please contact the application administrator for that application. Examples include: Kronos, OMS, RMS, Avatar, eWISACWIS, CARES, KIDS etc.

*AS/400 ACCESS CHANGES REQUIRED *

(Please indicate if any AS/400 Access needs to be changed)

Add Access Add Access

BCLAND – Treasurer☐BCGEN – Sheriff☐

BCLAND – PALS☐BCGEN – Finance ☐

BCLAND – Municipality☐BCGEN – Health☐

BCLAND – Assessor☐

BCGEN – Human Services ☐BCGEN –☐

Other Notes:

For TS Use Only

Page 1 of 2Updated December, 2016