ATTACHMENT_2,_REQUEST_FOR_KENNEDY_CENTER_IDENTIFICATION_BADGE,_201402.docx

Check ID Request Type: |_|New |_|Renewal |_| Update Information |_|Replacement Check Yes or No: KC Computer Network Log In Access Required. |_| Yes |_| No

Part 1: COMPLETED BY APPLICANT

Street

Month, Date, Year

last 4 digits only

IMPORTANT NOTICE

THE KENNEDY CENTER IS AN INSTRUMENTALITY OF THE UNITED STATES GOVERNMENT. MISUSE OF THIS IDENTIFICATION IS PUNISHABLE UNDER VARIOUS STATUTES, TO INCLUDE 18-USC-701.

this identification badge is the property of the kennedy center, and must be surrendered or returned upon request, or upon termination of employment or association with the kennedy center.

A $20.00 PROCESSING FEE WILL BE CHARGED FOR REPLACEMENT OF ALL LOST OR DESTROYED PHOTO IDENTIFICATION BADGES.

APPLICANT SIGNATURE:

REQUEST FOR KENNEDY CENTER IDENTIFICATION BADGE

PART 2: COMPLETED BY AUTHORIZING OFFICIAL

RFID-Rev B For Official Use Only Rev. Feb. ‘2014 Information contained in this ID request is for the use of the Office of Security ID Office only. Do not photocopy this document for other office or department records. Requests with incomplete information, illegible writing or photocopied authorization signatures will not be processed.

|_| KC Permanent Staff * |_| KC Part Time / Temporary Staff *

Dept. / Company: _____________________

Job Title: _____________________________

Expiration:

|_| Affiliate __________________________ |_| Contractor _______________________ |_| NSO Staff ** |_| NSO Musician ** |_| Stagehand ______________________ |_| Restaurant |_| Temporary ________ |_| Intern |_| Fellow |_| Volunteer ________________________ |_| Other ___________________________

* First issue requires KC HR Authorizing Official’s Signature ** Requires NSO HR Authorizing Official’s Signature Authorizing Official’s Signature:

(Required)

Date:

Printed Name & Title: (Required)

FOR USE BY ID OFFICE ONLY

Comments: ______________________________________Format Code: ________ Expiration Date: _____/______/______ ___________________________________________________________________ Processed Date: _____/______/______ |_|Identity Verification ID # _______________________________________________ KC ID #________________________ |_|Identity Verification ID Type: ____________________________________ Processed By: __________________________ NOTE: AUTHORIZING OFFICIAL IS RESPONSIBLE TO ENSURE THE PROMPT RETURN OF ID BADGE TO THE ID OFFICE UPON TERMINATION OF THE APPLICANT”S AFFILIATION WITH THE KENNEDY CENTER.