09-2015
NEW EMPLOYEE OFFICE/SPACE REQUEST FORM
Instructions: Use this form to begin the authorization process for new (or newly full-time) employee
office/space requests and to notify ITS about the new office or space technology needs. Please print clearly and
provide the requested information to ensure that the new workspace is ready for use. The form will not be
processed without proper signatures. Send completed original to: Sherrill.Holmes@cpcc.edu
Employee Name: ____________________________________________
Employee ID: ___________________
Date: _____________________
(Circle one)
Full-Time or Part-Time
Job Title: ____________________________________________________
Requested Office Space: Room _________________________
Building _____________________________
Tell us about the new space:
Are there electrical outlets? _________
Is there a network/phone outlet? ________
(STOP: If either answer above is ‘No’, a work order request to install the missing outlet(s) must be submitted and completed
before the process can go any further. ITS cannot prepare the space as needed if they’re not already in place.)
Is there an existing telephone in the new location? _______
Is there an existing workstation? _______
Please provide the computer name (i.e. CH100-01): _______________
(To find name: Click Start Button and look under My Computer)
Other devices or special software to be installed: __________________________________________________________
Contact Info and Authorization
Division Name: _________________________________________________________
Date: ______________________
(Please print clearly)
Supervisor/Manager/Dept. Head: ________________________________________
Phone: _____________________
(Please print clearly)
Contact Person: ________________________________________________________
Phone: _____________________
(Please print clearly)
Campus Dean and/or Division VP/AVP
Executive Director of Facilities Management
Signature: ___________________________________
Signature: ___________________________________
Date:
Date:
___________________________________
___________________________________