A completed badge application must be submitted to the Security office by each individual when having their badge made. ID badge applications can be picked up in room H-105. The information provided will assist with the completion of the application. Each applicant must have a government issued ID to verify their identity prior to having their ID badge made.

Name - Print the applicant’s name (last name, first name, and middle initial).

Preferred Name - Print the preferred name.

Date of Birth - Fill in the applicant’s birthday.

SSN - Fill in the person’s social security number.

Credentials - Fill in this box only if the applicant has a credential requirement for their job.

Campus Telephone - Fill in the person’s departmental telephone number.

Account Number - Enter the account number to be billed. Fill this out only if the department is paying for the ID badge.

Employee job title or resident/student - Print the applicant’s job title for hospital employees. If the applicant is working in a different area (i.e.: College of Medicine, College of Dentistry), the department may choose to have the name of the area instead of the job title. This line will show up on the back of the ID badge.

Departmental Name - Print the applicant’s departmental name. This line will show up on the front of the ID badge.

Department Code - Enter the department code, this line must be filled out.

Department Address - Enter the department’s address. The speed sort must be included.

First ID, Replacement - Check the appropriate box.

Date - Enter the date the photo was taken.

Signature - This is where the applicant signs his/her name.

Authorizing Signature - There are only three individuals from each department authorized to sign off on keys and ID badge applications.