PeopleSoft Security Form
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This form must be signed by the user’s manager. If requesting access to a PeopleSoft module that is outside of the requesting manager's area of authority, then an additional signature from that appropriate area requires an additional signature granting permission. Please forward this completed form to the Information Technology Office. Empl ID is Employee ID or Student ID number. |
Please Type or Print Clearly
| New Users Name: | |||
| Phone: | Empl ID# | ||
| Division/Dept. : | Position/Title: | ||
| Type of Request: (check one) | New User: Existing User: | ||
| *Windows Account | |||
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* Must have a Windows Login account before requesting PeopleSoft User ID. |
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Check Database: |
HR/SA > Live Production |
HR/SA Test |
HR/SA Q/A |
| HR/SA
Pre-Production |
Specify Other | Specify Other | |
PeopleSoft Module Access Authorization
User ID or User Name: New User Name:
Manager's
Name:
Date:
Manager's Signature:______________________________________________
Authorizing
Manager's Name:
Authorizing Manager's Signature:___________________________
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To be completed by Information Technology: |
| User Name: __________________ Account: _______ Created By: _______________ Date: ________ |
| Form Revision Date: 05/01/2017 |