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Application Form for Out of Hours Access to the Hospital Library
I wish to apply to use the Library outside normal opening hours and to be issued with a fob to facilitate access. I understand that access will be subject to the
conditions of use
, which I have read and accept. I authorise the Library to obtain my residence / forwarding address from my employer if it becomes necessary to contact me.
*
Indicates required field
Your title
*
Dr
Mr
Mrs
Ms
Miss
Your Name
*
First
Last
Your Position
*
Your Department
*
Library use only:
ID/Employer checked (initial and date)
*
Library staff use only
Fob issued (initial/date)
*
Library staff use only
Own fob used (initial/date)
*
Library staff use only
User chased for fob (initial/date)
*
Library staff use only
Fob refund for libray (initial/date)
*
Library staff use only
Your Home/Residence Address
*
Line 1
Line 2
City
State
Zip Code
Country
Date your contract ends (if non-permanent staff)
*
I have read and agree to the conditions of use (see link above). I understand that breach of these terms may result in fob access being withdrawn
*
I agree
Submit