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ID Card Request Form For A Rensselaer Retiree

This document is an ID card request form for retirees from Rensselaer Polytechnic Institute. It collects information such as the retiree's name, title, retirement date and department. It asks which campus facilities and resources the retiree is requesting access to, such as the library, athletic facilities or computer labs. The form must be signed by the retiree's dean or vice president and also requires approval from HR and campus card office. Retiree ID cards are valid for 12 months and must be renewed annually if longer access is needed.

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37 views

ID Card Request Form For A Rensselaer Retiree

This document is an ID card request form for retirees from Rensselaer Polytechnic Institute. It collects information such as the retiree's name, title, retirement date and department. It asks which campus facilities and resources the retiree is requesting access to, such as the library, athletic facilities or computer labs. The form must be signed by the retiree's dean or vice president and also requires approval from HR and campus card office. Retiree ID cards are valid for 12 months and must be renewed annually if longer access is needed.

Uploaded by

aniktmi
Copyright
© Attribution Non-Commercial (BY-NC)
Available Formats
Download as PDF, TXT or read online on Scribd
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ID Card Request Form for a Rensselaer Retiree


Portfolio Name: Retiree Name: Title: Date of Retirement: Effective dates of request: From: Department: RIN: Faculty F Staff F

(note: an Employment Transaction Form (ETF) must be submitted) Until (end date of 1 year or less is required):

Requesting ID Card Access to (check all that apply): Rensselaer Library F Rensselaer Athletic Facilities F Computer Labs F Other: Building/Room____ F No F If yes, explain below.

Is there a risk associated with granting Rensselaer ID Card post retirement? Yes F

I understand that by requesting that a retiree ID Card to this retired faculty or staff member, that I am responsible for ensuring that the cardholder is aware of and has agrees to abide by Rensselaers current policies on standards of conduct and harassment. I further understand that this privilege may be revoked at any time for any reason. Submitted By:

Dean/Vice President Request is:

Date

Provost (Faculty Only)

Date

Approved as requested Recommended alternate action (specify):

Denied

Vice President for Human Resources (or designee)/Date

Vice President for Administration (or designee)/Date

HR and Campus Card Office Use Only Retirement Date Confirmed (HR staff/Simon) ID Card Information Confirmed (Campus Card Office staff) Account Request Complete (Campus Card Office staff) Note: When an employee separates from Rensselaer, the department should return the employees ID Card and return it to the Campus Card Office (CCO). The CCO then updates SIMON. If the separated employee does not return his/her ID Card upon retirement, he/she should submit the ID Card to the CCO before the Retiree ID Card can be issued. If the ID Card was lost or stolen, the fee for the retiree is $10 for the first replacement, and $25 for each replacement thereafter. Retiree ID Cards are approved for a 12-month period only. If a longer request is needed, a new form must be submitted annually. Requests are reviewed monthly, and should be submitted more than 5 weeks in advance to ensure uninterrupted access.
V:/GeneralOffice/Forms/RetiredFacultyStaffIDCardRequest.doc July1,2010

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