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APPLICATION FOR A STAFF IDENTITY CARD Please complete this form and return to Security Office in 1E20 together

with a colour photography of Passport type and Passport quality, securely attached to the form and with your name printed clearly on the reverse. Please complete in block capitals with a ball point pen

Please use Blu-Tac or similar to secure photo. Do not staple or Sellotape.

The Identity Card provides proof of University staff status and enables you to use University facilities such as the Library and Computer services as well as granting you access to buildings, car parks and certain rooms. This card must be produced if requested by security personnel. This card will last for the duration of your employment. Please report lost of card to Security Services room 1E20 Frenchay X82866. Surname: ________________________________ Forename: _______________________________ Preferred forename ________________________ Faculty/Department ________________________ Signature: ______________ Campus ____________ Title: _______________

Date: ____________

Access Level (if applicable) ________________________ Signature of Dean/Head ___________________________

FOR SECURITY OFFICE USE ONLY Staff No. ___________________ Back No: _____________________

Date Issued __________________ Collected By __________________________

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