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HOD/IRES Request Form

IRES and/or HOD request (check all that apply).

* = required fields.

Applicant Information: (All information must be filled out for request to be processed.)

Employee First Name:

Middle Initial:

Employee Last Name:

SSN:

Telephone:

Fax:

Company:

CLEC's Email address:

* Required for IRES Request

Company Street Address:

Company City/State/Zipcode:

Manager's Email Address:

* Required for HOD Request

Employee Email Address:

* Required for IRES Request

CCNA:

* Required for HOD Request

Company Code OCN(s):

* Required for IRES Request

Manager's Name:

* Required for HOD Request

Manager's Telephone:

* Required for HOD Request

HOD/IRES Application Action:

Add
Delete
Password Reset

NON-DISCLOSURE AGREEMENT:Your individual sign on is to be kept confidential and in no way shared with any other person. If an individual in your department or any other department needs access, they must submit a request through their manager. Be advised that divulging your id/password is a violation of the non-disclosure agreement and could result in disciplinary action and/or loss of system access. (DATA SECURITY)

NOTICE: Customer shall be responsible for all acts and omissions of the employee named above in connection with access to the system, regardless of the employee's employment status with Customer, until EMBARQ has received and processed the Request Form deleting the employee's system access.

If you need more information or have questions , please e-mail helpdesk.ires@embarq.com

PCS Web Site sections:

Section links:

HOD/IRES Request Form