New User Request Form

Request for New User Account

Please note requests are usually completed with 7 - 14 working days, if you require this sooner please let us know.
Full Name

First NameLast Name
Team or Department Name
Role or Job Title
Type of employee
What is the employment type
Employee type
Equipment needs

Please specify any equipment that is needed:
Equipment list:
Equipment Requirement
Other needs
Please specify any further requirements
Date postion starts & Line manager
Required Start Date

DayMonthYear
Date
Location at start date
Start Date

MonthDayYear
Will the Start Date also be the Onboarding date for ICT accounts?
Please tell use the onboarding date for ICT accounts?

MonthDayYear
Date
Please tell use the onboarding date for ICT accounts?

MonthDayYear
Location at start date
Contact details

For a point of reference who should we make contact with for any addtional information
Line Managers Name

First NameLast Name
Line Managers Email address
Please use your Birmingham Hospice email address, not NHS Mail
Contact Name

First NameLast Name
Category
Project
Should be Empty:

Request for New User Account