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6 <br />DATE: <br />CELLULAR DEVICE AUTHORIZATION FORM <br />Approved: Q <br />Denied:. Q <br />Employee Name: Job Title: <br />Department: Division: <br />Phone: E-Mail: <br />Allowance Start Date: Amount of Stipend: TIER # <br />Please check all that apply: <br />^ Business critical ^ More than 50% away for the office <br />Business Justification: <br />Employee Certification: <br />By completing this form and signing below, 1 do certify that I have read the County's cellular device policy and agree to its <br />terms and conditions during my employment. I certify that the approved allowance will be used towards expenses I incur <br />for the cellular device. as described in the policy. <br />Employee Signature Date <br />Department Head Certification: <br />I have reviewed the above request and do hereby certify that the employee qualifies under the County's cellular device <br />policy requirements. <br />Department Head Signature Date <br />County Manager Certification: <br />County Manager Signature Date <br />Financial Services ~ Proposed Cell phone Reimbursement Policy <br />