Employee ID #___________ Name:___________________________________________
School/Site: _____________________ ________
Home Address: ________
Home Ph: __________________________Alternate phone: ________________________
Key Id #
Description (room, bldg, etc)
Date
Issued
Date
Returned
Notes
PLEASE READ THE FOLLOWING STATEMENT BEFORE SIGNING:
Your signature below signifies that you understand and accept the following terms and conditions.
1.
Key(s) are not to be duplicated in any way.
2.
Keys are not to be loaned or given to personnel other than the authorized signature on this form.
3.
Key(s) are to be returned in person to your supervisor upon leaving the Districts employment, or accepted by an authorized representative of Everett Public Schools.
KEYS ARE NOT TO BE MAILED.
4. You are responsible for the security of the above listed key(s) at all times. If the key(s) are lost or stolen, you may be responsible for the cost for re-keying of the affected facility and/or facilities.
I, , have read the above terms and conditions for Everett Public Schools key(s) and do hereby agree to them.
