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Employment Agency Badge Requests
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UO-Affiliated customers use this service to request badges for employees hired through employment agencies.
Title
A short description to explain the nature of a ticket.
Agency
Number of Badges
1
2
3
4
5
6
7
8
Contact Name
kbethke@uoregon.edu
Contact Phone and Extension
Note:
If have the person's 98 number, enter here; otherwise, leave it blank.
Provide the name for Employee 1
Provide the preferred name for Employee 1
98# of Employee
If the employee needs a 98 number, fill in this field once the new 98 number has been provided.
Prox Access for Employee 1?
Prox Access for Employee 1?
Yes-prox access required
No-prox access NOT required
Department for Employee 1
Department for Employee 1
Custodial
Dining
Other
What other department for Employee 1?
Provide the name for Employee 2
Provide the preferred name for Employee 2
98# of existing card for employee 2
Prox Access for Employee 2
Prox Access for Employee 2
Yes-prox access required
No-prox access NOT required
Department for Employee 2
Department for Employee 2
Custodial
Dining
Other
What other department for Employee 2?
Provide the name for Employee 3
Provide the preferred name for Employee 3
98# of existing card for employee 3
Prox Access for Employee 3
Prox Access for Employee 3
Yes
No
Department for Employee 3
Department for Employee 3
Custodial
Dining
Other
What other department for Employee 3?
Provide the name for Employee 4
Provide the preferred name for Employee 4
98# of existing card for employee 4
Prox Access for Employee 4
Prox Access for Employee 4
Yes
No
Department for Employee 4
Department for Employee 4
Custodial
Dinining
Other
What other department for Employee 4?
Provide the name for Employee 5
Provide the preferred name for Employee 5
98# of existing card for employee 5
Prox Access for Employee 5
Prox Access for Employee 5
Yes
No
Department for Employee 5
Department for Employee 5
Custodial
Dining
Other
What other department for Employee 5?
Provide the name for Employee 6
Provide the preferred name for Employee 6
98# of existing card for employee 6
Prox Access for Employee 6
Prox Access for Employee 6
Yes
No
Department for Employee 6
Department for Employee 6
Custodial
Dining
Other
What other department for Employee 6?
Provide the name for Employee 7
Provide the preferred name for Employee 7
98# of existing card for employee 7
Prox Access for Employee 7
Prox Access for Employee 7
Yes
No
Department for Employee 7
Department for Employee 7
Custodial
Dining
Other
What other department for Employee 7?
Provide the name for Employee 8
Provide the preferred name for Employee 8
98# of existing card for employee 8
Prox Access for Employee 8
Prox Access for Employee 8
Yes
No
Department for Employee 8
Department for Employee 8
Custodial
Dining
Other
What other department for Employee 8?
Attach photo of the individual (rename photo with full name)
Attach a photo of each individual and name each using the employee's full name.
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Description
The full details of a ticket, including any appropriate circumstances or supplementary information that may aid in resolving it.
Press Alt + 0 within the editor to access accessibility instructions, or press Alt + F10 to access the menu.
Other Fields
Your name
Your first name
Your last name
Your email address
Your phone number
Verification Code