ACCESS AND EQUIPMENT REQUEST / CHANGE FORM

INFORMATION SERVICES
Template Version 8, from Sep 01, 2015

1. USER BASIC INFORMATION

Please complete all necessary fields. Those marked with * are MANDATORY and must be populated to be processed.
New Employee Corporate Policies Training, CPT, will be scheduled Change Employee Suspension Please indicate "Termination Data Handling and Special
Type: * for this new user Instructions" in Section 4
New Contractor X Change Contractor Termination
Please add here the resumption date for employees´termination or Contractors contract´s expiration date
Date Requested: * 2/24/2020 Resumption/Termination Date *: 2/23/2022

First Name: * Carolina Last name: * Cortes Middle Initials: CC

Job Title: * Profesional contratación de servicios Location: * Bogota Supervisor Name * Hugo Molina
Country: * Colombia City: * Bogota Department * Contratación de Servicios

Authorized by: * Authorized by: *

Signature | Name | Position

user´s Senior Manager IT Regional Lead

* If different than the Sr Manager, please provide copy of the Delegation Of Authority for person signing on behalf.

2. ACCESS AND APPLICATIONS

SYSTEM ACCESS APPLICATIONS ACCESS
Email X Business Systems
VPN Access X Please indicate what applications this user needs access for and the environment if applies. Also, add a description of the kind of access and
Workstation permissions he/she needs or what kind of actions are required to be performed on the system:
AD Renewal
Application Environment Access details:
Standard Network Share Read Write Same roles as Carolina Cortes has
SAP PRD
currently

Add details
Add details
Add details

FTP Access (Fill in Folder Path)

Add details

3. EQUIPMENT
Type: Desktop Laptop
COMPUTER NOTES:
Use: Common Technical Advanced
Type: Common Smartphone Avantel/Satellite
CELL PHONE NOTES:
Roaming
(Permanent): Yes No
4. TERMINATION DATA HANDLING & SPECIAL INSTRUCTIONS
Please provide specific instructions on how to handle the information managed by the user after suspending / terminating his/her account.
If there is a need to have access to former employees or contractor an extra form (Acknowledge and Agreement Computer / Email) must be filled (Please ask your local IT support team or find the form in the
share drive M: path: M:\Policies in english\Information Technology\ARCF")

5. ADMINISTRATIVE ACCESS (IT staff only)

System Administration
Citrix Administrator Email Server Administrator Network Administrator VPN Server Administrator
Domain Administrator Iron Mountain (per attached sheet) SQL Server Administrator Helpdesk
IMPLEMENTATION DETAILS
(for IT internal use only)
(if GTEC / GTEP contractor then namelastname-company@grantierra.com)

Email Address assigned: carolinacortes-eam @grantierra.com

Name, Position & Signature
VPN user name assigned:
IDEAS user name assigned: Head office implementation by: Date:
User name assigned:
FTP user name assigned:
Name, Position & Signature
Assigned Phone extension
LMS Account assigned: # Ticket Regional Office Implementation by: Date:

Details of analysis done for Applications access requested

Analysis performed by:
Roles Assigned: SOD that apply (IDEAS Only): New Roles / other details required? YES NO
If YES, please specify which ones and why:

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