"Dsw Id Badge Replacement Request Form" - City and County of San Francisco, California

Dsw Id Badge Replacement Request Form is a legal document that was released by the Department of Human Resources - City and County of San Francisco, California - a government authority operating within California. The form may be used strictly within City and County of San Francisco.

Form Details:

  • Released on April 1, 2016;
  • The latest edition currently provided by the Department of Human Resources - City and County of San Francisco, California;
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DSW ID BADGE REPLACEMENT REQUEST
CITY AND COUNTY OF SAN FRANCISCO
DEPARTMENT OF HUMAN RESOURCES
INSTRUCTIONS:
1.
The submission of a DSW ID Badge Replacement Electronic Service Request (ESR) is required for the printing of all
badges except for those requested through the Appointment Processing Form.
2.
The ESR must be submitted by a designated Department Human Resources Personnel.
3.
Each ESR allows for the submission of one (1) employee badge request. For requests of two (2) or more employees,
complete the following spreadsheet and submit with ESR as an attachment:
http://dhrportal.org/wp-
content/uploads/2016/04/DSW-ID-Badge-Processing-Template.xlsx
4.
The department contact will be notified when the badge(s) is ready for pick-up.
Date of Request:_____________
Department Contact:_________________________ Email:______________________ Phone:__________________
SECTION I: REQUEST INFORMATION
Type of Request: _____________________________
Quantity:________
Select One
(Processing fees may apply)
(New Hire badges, except for MTA specific classes, should continue
to be requested through the Appointment Processing ESR.)
If other, please state reason: _______________________________________________________________________
(i.e. initial request not made on original Appointment Processing Form)
SECTION II: CARD INFORMATION
Employee Name: __________________________ DSW ID #___________ Social Security # ____________________
(Last, First, M.I.)
Department Code:_______ Job Code:_______ Job Title:_____________________________ Empl Class:__________
Select One
Type of card:
Regular
Smart Card
City Hall
(For buildings that require Smart Card access ONLY)
SECTION III: DEPARTMENT BILLING INFORMATION
Index Code: __________
Sub-object:__________
Accounting Contact:_________________________ Email:______________________ Phone:__________________
SECTION IV: DEPARTMENT AUTHORIZATION
The Appointing Officer/Authorized Designee named below hereby approves this request and certifies that the information provided
on this form is accurate and complete.
_______________________________________________________________________________________________
Appointing Officer/Authorized Designee Name
Date
_______________________________________________________________________________________________
Phone Number
Email Address
SECTION IV: PROCESSING INFORMATION (DHR Use Only)
Completed
Not Completed - Reason:__________________________________________________________
Smart Card #:___________________________________________________________________________________
DSW ID Badge Completed By:
Date
(Rev. 04/2016)
DSW ID BADGE REPLACEMENT REQUEST
CITY AND COUNTY OF SAN FRANCISCO
DEPARTMENT OF HUMAN RESOURCES
INSTRUCTIONS:
1.
The submission of a DSW ID Badge Replacement Electronic Service Request (ESR) is required for the printing of all
badges except for those requested through the Appointment Processing Form.
2.
The ESR must be submitted by a designated Department Human Resources Personnel.
3.
Each ESR allows for the submission of one (1) employee badge request. For requests of two (2) or more employees,
complete the following spreadsheet and submit with ESR as an attachment:
http://dhrportal.org/wp-
content/uploads/2016/04/DSW-ID-Badge-Processing-Template.xlsx
4.
The department contact will be notified when the badge(s) is ready for pick-up.
Date of Request:_____________
Department Contact:_________________________ Email:______________________ Phone:__________________
SECTION I: REQUEST INFORMATION
Type of Request: _____________________________
Quantity:________
Select One
(Processing fees may apply)
(New Hire badges, except for MTA specific classes, should continue
to be requested through the Appointment Processing ESR.)
If other, please state reason: _______________________________________________________________________
(i.e. initial request not made on original Appointment Processing Form)
SECTION II: CARD INFORMATION
Employee Name: __________________________ DSW ID #___________ Social Security # ____________________
(Last, First, M.I.)
Department Code:_______ Job Code:_______ Job Title:_____________________________ Empl Class:__________
Select One
Type of card:
Regular
Smart Card
City Hall
(For buildings that require Smart Card access ONLY)
SECTION III: DEPARTMENT BILLING INFORMATION
Index Code: __________
Sub-object:__________
Accounting Contact:_________________________ Email:______________________ Phone:__________________
SECTION IV: DEPARTMENT AUTHORIZATION
The Appointing Officer/Authorized Designee named below hereby approves this request and certifies that the information provided
on this form is accurate and complete.
_______________________________________________________________________________________________
Appointing Officer/Authorized Designee Name
Date
_______________________________________________________________________________________________
Phone Number
Email Address
SECTION IV: PROCESSING INFORMATION (DHR Use Only)
Completed
Not Completed - Reason:__________________________________________________________
Smart Card #:___________________________________________________________________________________
DSW ID Badge Completed By:
Date
(Rev. 04/2016)