Employee ID Tag Request

Photo guidelines:

"*" indicates required fields

URL

This field is for validation purposes and should be left unchanged.

Legal Name*

(as it appears on your SIN card)

First Name Middle Name Last Name

(please complete in full to avoid delivery delays & returned mail)

Contact Name*

IERHA Site Name*

IERHA Site Address

Tag request for:*

New Employee

Lost ID

Damaged Id

New Position

Badge type:*

Clip

Lanyard

Lanyard or Clips are provided for NEW & LOST IDs, or if they are damaged
A non-refundable $20 fee. processed via payroll deduction for replacing LOST IDs
Damaged IDs must be returned to ID Badge Requests at: Corporate Office (please include this form)
Old IDs must be returned to Badge Requests at: Corporate Office (please include this form)

Notes:

First or Preferred Name*

How would you like your name to appear on you ID

Position*

DO NOT use abbreviations for Position

Employee type?*

IERHA

Shared Health

IERHA employee ID #

Shared Health employee ID #

Attatch an image:*

Please make sure that the image has a plain background, and it displays your shoulders and above.

Accepted file types: jpeg, jpg, png, bmp, gif, Max. file size: 10 MB.