IT – New Employee\Internal Transfer – Cypress Healthcare In-House

YOUR Email address*

New Employee\ Internal Transfer

New Employee

Internal Transfer

New Employee Name*

Prefix

First

Last

Job Title*

Department*

Company*

Manager (reports to)*

New Employee Email*

New Employee Email Groups

Shared drives needed*

Ex... CHC shared drive, Callcenter share, etc...

Location*

Office\Cubicle Location*

Please list what office/cubicle location/area the new employee will be working in.

Start Date

Accounts that need to be created

Harvest

Advanced MD

Computer\Server

Email

please check any accounts that need to be setup for this user

Does this employee need a phone\extension?*

Yes

No

Does this employee need a computer?*

Yes

No

Does this employee need a desktop printer?*

Yes

No

Does this employee need a laptop bag?*

Yes

No

Additional Software:

please be specific

Additonal requests\notes

This field should be left blank