Town of Chapel Hill
Employee Home Education Computer Checkout Program
Employee Name: _____________________________________
Computer Description:
Model: _____________________________________
Service Tag: _____________________________________
Standard Package Contents: CPU, Keyboard, Mouse, CRT Monitor, Power Cable
Windows 2000 Operating System
Extra Items (list): _____________________________________
_____________________________________
Check-out Date: _____________________________________
Scheduled Return Date: _____________________________________
Program Conditions: The computer and associated items is provided for the employee’s use at home for educational and personal use and must be returned to the Town of Chapel Hill at the scheduled return date (normally one year from check-out) or earlier if the employee no longer desires to use the equipment or terminates employment with the Town. The equipment is provided on a non-warrantee basis. The Town of Chapel Hill will not provide maintenance support for the equipment however the employee may purchase support or repairs for the system on a non-refundable basis. If the equipment fails to operate and the employee does not wish to pay for repair or maintenance, the system should be returned to the Town for disposal. If the employee fails to return the system to the Town of Chapel Hill by the scheduled return date, the employee will be subject to repayment of the fair market value of the equipment (not to exceed $300.00).
Employee Acceptance: I accept the above equipment subject to the terms of this agreement:
Employee signature: _______________________________________
Date: _______________________________________
IT Department signature: _______________________________________
Date: _______________________________________