CPS IT New Hire, Change in Service, &
Termination of Service Request

Please fill in all fields before submitting.

Please give the full name of the person that this request is for:
First Name:
Please give the full name and e-mail address of the person making this request:
Requestors E-Mail:
Please indicate the type of request:

Please give us specific information about their position and needs:

Entity employee hired by:

Job Title:

Office Location:

Start Date:


Part Time or Full Time Staff:


Computer Required:

Telephone Required:

Voicemail Required:

Mobile Phone:
PDA Justification:

Keys Required:

Required Key Locations:
Please indication what CPS speficific accounts need to be created or added:

Peoplesoft Account Specifics:


CPS Mailing List Specifics:

E-Mail Account (CPS):

Please indication what Training Centers specific accounts need to be created or added:

Peachtree Account:

Aceware Account:

TC Mailing List - Full Time:

TC Mailing List - Part Time:

TC Key Card:

TC Alarm Code:

VPN Account:

VPN Account Justification:
E-Mail Account (TC):

Termination of Service Specific Questions
Please enter the e-mail address of the employee who is leaving.
E-Mail Address:
Exit Date: ,
Termination of Service specific comments: