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2. City Employee Access Card Request Form
   This form is for City of Boulder City Employees only. If you have any questions about this form or how to use it please contact the Police Department at 702-293-9224 or accessrequest@bcnv.org.
4. Type of Request*
   -- Select One --Access Card RequestMechanical Key Request
6. Requestor's First Name*
7. Requestor's Last Name*
9. Requestor's Email Address*
10. Requestor's Department*
12. Employee's First Name*
13. Employee's Last Name*
15. Employee's Title Per Their Personnel Action Form*
17. Employee's Department*
19. Employee's Division*
21. Employee's Number*
23. Description of Access Card Functionality (Which doors should it work?)*
25. Reason for New Access Card*

    1. New Employee
    2. Lost
    3. Stolen
    4. Damaged
    5. Other
26. What Type of Access Card?*

    1. Full-Time Employee
    2. Part-Time Employee
    3. Contract Employee
    4. Volunteer
28. Verification of Information*

    1. By checking here you have verified all information and spelling and understand that the access card will be created exactly from the information provided.
Leave This Blank:


30. 1. Receive an email copy of this form.
31. Email address

    This field is not part of the form submission.

32. Submit

* indicates a required field