Transcription of Request For Parking Privileges – DAILY PAY
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Request For Parking Privileges – DAILY PAY
Revised: 30april2014/er Request For Parking Privileges DAILY PAY Applicant s Personal Information: ** ALL FIELDS REQUIRED. INCOMPLETE FORMS WILL NOT BE PROCESSED** Title (circle one): DR. MR. MRS. MISS MS. INPUT SITE: (see reverse page) LAST NAME: FIRST NAME: Employer / Affiliation: PHC PHSA VCH FHA Employee ID # or PHY Billing #: Dept.: Work Phone #: Ext.: Mobile/Pager/Home Phone #: Work Email: Personal Email: Office Address: (Street) (City) (Postal Code) Home
Request For Parking Privileges – DAILY PAY . ... o PHYSICIAN – with medical affairs/administration (must have active hospital privileges and provide medical services) o EMPLOYEE – as a health authority staff ... c/o BC Children’s Hospital & Women’s Health Centre . Shaughnessy Bldg. Room AB 100 .
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