This document is a network account request form for adding, deleting, or modifying a user's network account at the Department of Labor-ETA (DOL-ETA). It requests information about the user such as name, office, and phone number. It also specifies what type of account is being requested (permanent, temporary, or emergency) and what actions should be taken (add, delete, move, etc.). Supervisor authorization and completion of computer security training is required before enabling the account. The form requests details about which applications and systems the user requires access to.

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ETA Network Account Request Form
NOTE: Computer Security Orientation is Mandatory Prior to Enabling an Employee’s Network Account
1. USER INFORMATION: (Please Print or Type) Is user a contractor? No Yes Company DOL-ETA
Last Name: First Name: Middle Initial:
Office: Division:
Room No: Building: Phone:
2. IDENTIFY TYPE OF NETWORK ACCOUNT: PERMANENT TEMPORARY EMERGENCY
3. ACCOUNT ACTION REQUESTED: ADD X DELETE DISABLE MODIFY MOVE
MOVE ACCOUNT FROM: MOVE ACCOUNT TO:
MOVE HARDWARE FROM:
MOVE HARDWARE TO:
If DELETED or MOVED should work files transfer to another person? YES NO X
If YES, to whom? User ID
Files Requested:
*All e-mail will be deleted if an account is deleted.
Does user have an account on another DOL LAN? YES NO X
If YES, which DOL LAN? Account Name:
4. AUTHORIZING SIGNATURE:
Prior to authorizing, I certify that I have verified the account requestor’s identification with one of the following forms of ID: U.S. driver's
license, U.S. State-issued non-driver identity card, U.S. passport, or Federal DOL ID card.
Immediate Federal
Supervisor/Contracting
Officer Technical
Representative
Date:
Typed or Printed Name and Signature
Employee: Date:
Typed or Printed Name and Signature
5. SUBSCRIPTION SERVICES REQUESTED: (Determined by Agency Management)
Type of Access Required:
General Users
Standard ETA Build OTHER Specify
Information Technology Application Users
Application Developer Web Administrator OTHER Specify
Information Technology Operations Users
Unix Systems Administrator Oracle Database Administrator Oracle Application Administrator Citrix Administrator
ColdFusion Administrator McAfee ePolicy Administrator Informix Database Administrator ProDocs Administrator
Desktop Administrator Content Switch Administrator Windows 2000 & 2003 Systems
Administrator
Biz Flow Administrator
Websense Administrator Switch & Router Administrator Active Directory Services
Domain Administrator
Firewall Administrator
OTHER Specify
Information Technology Security Users
Network Security Engineer Intrusion Detection/Prevention
Administrator
Security Analyst OTHER
Specify
Specify

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Applications Required:
E-Mail Mail Distribution Group Memberships Required (specify)
Specify application
CITRIX (Remote Access)
Complete the section below ONLY if there is a need for the individual to work remotely and he/she meets the following criteria: (Check all that applies)
Are you using government furnished equipment Yes No Note: For those who check No to this question, personally owned equipment
is being used.
PERMANENT TEMPORARY
Perform essential roles in an “actual” Continuity of Operations
Plan (COOP) or pandemic emergency
Participate in COOP or pandemic practice exercises
Require 24-hour access to network services or for address
administrative priorities (e.g., Office of Foreign Labor Certification
Certifying Official)
Need to work remotely on a temporary basis in response to disaster
relief efforts or other high priority activities
Work under a formal Flexiplace Agreement Federal Project Officer engaged in scheduled monitoring activities
Please complete the questions below. This information will be used tor reset your account in the event you lose your token or have forgotten your
PIN.
Security Questions 1 What is your favorite color?
Security Questions 2 What is your favorite hobby?
6. COMPLETION INFORMATION:
A. Has the User completed the Computer Security Orientation?
B. Has the User been instructed where to obtain the following information
technology security documents:
• ETA Computer Security Handbook (CSH), Chapter 101, Information
Technology Policy Manual;
• ETA CSH, Chapter 204, Information Technology User Procedures;
• ETA CSH, Chapter 30l, Volume 1, IT Personnel Security Procedures; and
• Operational Procedures Handbook, Access Authorization Procedures?
YES NO
YES NO
Date:
Date:
C. Has the user read and accepted the following security documents:
• Rules of Behavior for Mobile Users and Teleworkers?
• Rules of Behavior for System Administrators of Mobile Users and
Teleworkers (if a System Administrator of Citrix)?
YES NO
YES NO
Date:
Date:
User ID:
Hardware Assigned: RSA Token Token Type Assigned: Permanent Temporary
COMMENTS:
Token Processed By:
Printed name and signature
Date Completed:
Account Processed
By: Printed name and signature
Date Completed:
Revised 05/21/2009