7/30/2019 Id Application Form

1/1

KAUST- Research Park Utilities Plant projectsIdentity Cards

CNCEC-KAUST-HSE-IDCARD-013

REQUEST FOR IDENTIFICATION CARDDate: / /Permanent Employee CNCEC HSE Trainee Government Official * Permanent

Direct Hire Other * Temporary

New Renewal Change Replacement Lost

: Nationality : Job Title :

Name:

National ID # / Pass#. / Date & Issue Place Birth Date Blood Type

Iqama No. / Valid until / Work Location KAUST- Research Park Utilities Plant projects

Thuwal, Jeddah. KSA

Previous ID Card

Company / Est. Name & Tel Employ. Sign

Please complete all information & Sign in the specific place

For Safety Section Use Only

The above mentioned Employee has been given Safety Orientation by HSE Training Supervisor & proceeds to issue the CNCEC ID.

Safety Orientation given by: Name ___________________________ Sign: ____________________ Date: _________________

Security Access Control System

General Access

Level

A= Admin Main

B= Plant Entrance

C= Vehicle Entry

Sign:

HSES Dept. Manager Approval

Name:________________________

Signe:________________________

Date :________________________

For the period

Of:../.../... Until:...//..

* Please submit copy of Iqama, Passport, Service agreements and Blood Group cert. copy along with this Form* For Temporary ID please submit copy of Passport and Iqama along with this Form

* If anyone lost his ID then subject will be pay the penalty 300 SAR to re-issue the new ID

* The ID is the property of CNCEC HSES Department and has all rights to terminate if any serious violation occurs by ID holder.