If you are unsure about any of the questions on this form, then please phone the Helpdesk for confirmation.
Organisation Name (required)
Requested By (required)
Requester's Email (required)
Requester Phone Number (required)
Full Name of Leaver (required)
Leave Date (required)
Line Manager of Leaver
Line Manager Mobile Number
LEAVER'S ACCESS CHANGES REQUIRED:
Is LEAVER being replaced ? (please specify who is to replace - and maybe use the New User Form)
Does LEAVER's Email account need to be deleted or just disabled ?
If Mailbox is to be retained (ie not deleted) does anyone need to be given access ?
Did the LEAVER have access to a VPN connection - does this need removing ?
Which PC /Laptop(s) did LEAVER use ?
Will this PC/Laptop be passed to someone else ? (Please specify who)
Can the LEAVER'S PC/Laptop profile be removed (ie it is not needed again) ?
Any other requirements/ notes
If you need to request a New User (to replace this Leaver) then please use this Form
Call us on 0121 663 0203 or email firstname.lastname@example.org
Alternatively, fill in the form opposite and one of our team will call you back.