Do you need a badge or badge update?
Please complete the requirements below to apply for a new or updated badge
ID Badge Request Form
Please fill the information below accordingly
New Badge Request
Update Current Badge
Department Contracted By
(If you are unsure, ask your management/HR department. An incorrect entry will cause your application to be delayed or rejected)
Your Company Name
Your Company Name (Others)
First Name
Middle Name
Last Name
Driver's License # (or Government issued id)
Driver's License Issued State
Passport Number (if applicable)
B-1 Visa/ESTA (Foreign visitors only)
Email Address
Phone : (123) 456-7890
Date of Hire
Street Address
City
State
Zipcode
Date of Birth
Hair Color
Eye Color
Height
Unit
Weight
Unit
Emergency Contact Information
In the case of an emergency, notify:
Relationship
Emergency contact phone : (123) 456-7890
If unable to contact by phone, their place of employment
Upload files
Please upload required documents below
Step 1
Upload Drug Screen Document
Must provide a 10-Panel screening from a qualified service medical provider that was performed within;
Contractor : 30 days | Supplier : 6 months
Click to Upload Document
There is no file uploaded yet
Step 2
Company Approval Document
Document authorizing your badge request and signed by your company’s HR department
Click to Upload Document
There is no file uploaded yet
Safety Video
Please watch the safety video
Play Safety Video
Please finish watching the video for a next step!
( Next button will be automatically popping out when the video is finished playing )
Signature (Your initials)
Date
Do you need a Wifi?
Wifi access in WeNestIm network
YES
NO
Finish & Submit
Processing