ID Badge Deactivation Online Form

Notify the Credential Center immediately when a badge holder's employment has been terminated. Use this form for all termination notifications and badge deactivation requests. This form works best with Internet Explorer 8 or Mozilla Firefox 4. Not all browsers are supported.

* Required fields

*Deactivation Type: Employee Termination
Other Badge Deactivation

Company Information:
Employer Company Name    
Employer Contact Name    
Employer Contact Job Title    
Employer Contact Phone    ( -
Employer Contact E-mail    

Employee Information:
Last Name
,  
First Name
Middle Initial
      
Employee Job Title
POS Badge Employee# (if available)
Additional Comments

*Badge Possession Information:

Employer DOES NOT HAVE physical custody of this badge
Employer DOES HAVE physical custody of this badge

All information submitted through this notification online form request is subject to verification by the ID Access office with the company requesting the badge deactivation.