ID Badge Application Form

Are you requesting a new badge for yourself? *

Yes

Your Details

Forename *

Surname *

Organisation *

Other Organisation / School Name *

Work Email *

What are you in relation to the ID Badge recipient? *

Line Manager

Head of Service

Other

Please give details *

Work Telephone Number *

Service *

Job Title *

Who the ID Badge is for

Forename *

Surname *

Organisation *

Organisation details, Including Address *

School Name *

Work Email *

Work Telephone Number *

Service Area *

Team Name *

Job Title *

Line Manager Email *

Work Location

Work Location and Access *

Access to the Civic Complex will be restricted to those staff issued with a card token that is combined with ID Badges. If you require specific access to the complex but it is not your contracted work base, please answer the section below

Work Location Details *

Are you required to visit Stopford House / Fred Perry House / Town Hall as part of your role on a weekly basis? *

Yes

Reason for Request

Reason for new ID Badge *

If you have lost your badge or it has been stolen, we need details of this so that we can make the badge inactive.

Date that you last had the badge *

Place you last had the badge *

If you need a replacement ID Badge please return your expired / damaged badge to the HR Team on the 2nd floor of Stopford House

This option should only be used if a badge is needed to cover a period of time. Visitors should be registered through the 'Proxy Click system'

Temporary Period Start Date *

Temporary or Approximate Period End Date *

Please provide details of why this TemporaryID Badge is required *

Upload Image

You will need to provide a digital photo for your ID Badge to be produced *

JPG Only. Files no larger than 10Mb.

It must be a recent, colour photograph of just the head and shoulders with a plain background and free from shadows. We reserve the right to reject images that don't match these requirements.

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Budget/Charge Details

Cost Centre for ID Badge charges *