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City of St. Louis Department of Personnel Administrative Regulation NO. 106 - FORM |
The City of St. Louis Administrative Regulations have been converted to electronic format by the staff of the St. Louis Public Library. This electronic version has been done for the interest and convenience of the user. These are unofficial versions and should be used as unofficial copies.
Official printed copies of the City of St. Louis Administrative Regulations may be obtained from the Personnel Office at 1114 Market Street, Room 703, St. Louis, Missouri 63101.
City of St. Louis
City Employee Identification Badge
Request Form
This is to certify that the below named person is an employee of the below named department and is authorized to receive a City Identification Badge for the reasons outlined.
Employee Name: _________________________________________________
Employee Title: __________________________________________________
Department/Division (as it should appear on the badge):
______________________________________________
Department Number ______________
Please check one:
______ New Hire
______ Transfer/Promotion (employee will have old ID badge to turn in)
______ Name Change (employee will have old ID badge to turn in)
______ Damaged (employee will have old ID badge to turn in)
_______________________________ ________________________________
Payroll Clerk - Print Name Payroll Clerk - Signature
_______ Lost (employee will be required to pay $5.00 replacement fee)
_______ Stolen (employee will be required to pay $5.00 replacement fee)
______________________________ _______________________________
Appointing Authority - Print Name Appointing Authority - Signature
Submit this form to Citizens’ Service Bureau - City Hall Room 234 - Wednesdays between 9:00 a.m. and 11:30 a.m.
July 1, 2005
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