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VPN Request Form

This document is a remote access request form that must be completed to request virtual private network (VPN) access. It collects information about the remote user such as their name, job title, and site. It requires the requestor to select their job category and responsibilities, intended applications, and estimated hours of remote access needed. The requestor must provide a business justification and equipment details if using a company device. It requires multiple levels of approval including from the site director, IT operations manager, and information security.

Uploaded by

Marc Marino
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© © All Rights Reserved
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Download as DOC, PDF, TXT or read online on Scribd
345 views

VPN Request Form

This document is a remote access request form that must be completed to request virtual private network (VPN) access. It collects information about the remote user such as their name, job title, and site. It requires the requestor to select their job category and responsibilities, intended applications, and estimated hours of remote access needed. The requestor must provide a business justification and equipment details if using a company device. It requires multiple levels of approval including from the site director, IT operations manager, and information security.

Uploaded by

Marc Marino
Copyright
© © All Rights Reserved
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Tracking #      

Remote Access Request Form v1.4


Section I: Remote User information
VPN User Information
Site Director Name:       Date      
Site: Select site
Remote access requested for:
Name:       Job Title      

Section II: Justification for remote access

Virtual Private Network (VPN) access is provided to authorized employees, only. Approval is based on the requestor’s
job title, job duties, application/access requirements, and justified usage. Connection must be initiated using the Alorica
provided software installed only on company owned equipment. Alorica management and or security will review the
request and determine if the employee is eligible for VPN access.

Check the applicable boxes, and provide a justification and descriptions of your intended usage.

1. What category best describes your area of work?


Site Director:      
Sales:      
WFM:      
Project Manager:      
Other:      

2. What type responsibilities do you have that would require remote access? Please describe.
IT Support: Network Support: Telco Support: Application support
Account Managers:      
Payroll:      
Reporting:      
Other:      

3. What application(s) do plan to use that require remote access?


WFM      
Client Applications      
Payroll      
HR      
Other(s)      

4. Provide an estimate of hours that require remote access?


Daily       Weekly       Monthly      

5. Provide a business justification for why you need a laptop and remote access ?
     

6. What percentage of travel is required as a part of your job duties?


     
If an existing desktop or laptop is to be used the system unit must be cleared of all prior data and ensure it meets Alorica
software configuration standards. All equipment inventory information and serial numbers must be provided. All
equipment MUST be returned upon termination of employment or when no longer required.

Note: Remote users are NOT permitted to store any sensitive company/customer data (e.g. Payroll, SSN, Credit Card
data, or confidential information) on the systems local drives or any other mobile storage media device. You are
required to save sensitive company/customer data on a network drive. It is your responsibility to ensure the network
543089037.doc 9/19/2021 Page 1 of 2
drive used will be included in the enterprise backup schedule.

Tracking #      

Remote Access Request Form v1.4


Section III: Remote User Information
Remote access requested for:
Name:       Job Title      
Section IV: Equipment usage

7. What company owned equipment will this user be issued to utilize for remote access?
Order new Laptop. Order new desktop unit & Reissue current Reissue current Desktop
Monitor Laptop from site & monitor from site
inventory inventory
PR#       PR#       Mfg/Model       System Mfg/Model      
Copy of PR must be attached Copy of PR must be attached Serial Number       Serial Number      
___________________________ ___________________________
Monitor Mfg/Model      
System Mfg/Model       System Mfg/Model       Serial Number      
Serial Number       Serial Number      
Monitor Mfg/Model       Monitor Mfg/Model      
Serial Number       Serial Number      

Section V: Signatures/Approval

Actual signatures are required.


Please sign then email scanned copy with signatures.

Title/Name Signature Date


VPN Requestor: Enter users name here      
Site Director: Enter Site Ditectors name here      
IT Operations Manager: Roman Nakhmanson      
Data/Voice Manager: David Villa

Information Security: Info. Security name here      


Note: Director of Information Security approval is mandatory for any contactors, third parties, or non Alorica associates.

Section VI: Next Steps


This section is to be completed by the corporate staff only.

Completed Completed by:


SharePoint status updated:      
Equipment purchase approved:      
Added to inventory tracking:      
What access group that was provided: Corp Staff: Select group      
IT Notes:

The finished document must be filed with Information Security at the corporate office.

543089037.doc 9/19/2021 Page 2 of 2

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