04 Attachment B - OVR Contractor Personnel Confidentiality Form.pdf
PDF 587 KB Posted
- Attached to
- 12 OVR Enhanced Driving_Ancillary Supmtl
- Solicitation number
- 6100064131
- Issued by
- Adams County, Pennsylvania
About this file
This document is a Confidentiality Form for the Pennsylvania Department of Labor & Industry's Office of Vocational Rehabilitation (OVR), specifically designed for drivers contracted to provide transportation services. The form requires the driver to agree not to solicit, disclose, receive, or use any information concerning persons applying for or receiving vocational rehabilitation services, whether that information is derived directly or indirectly from their duties. The driver must maintain strict confidentiality about all matters relating to OVR employees and customers, with the understanding that breaching this confidentiality may result in contract termination.
The form is part of OVR's compliance and privacy protection protocols, ensuring that contracted drivers protect sensitive client information. It includes signature lines for both the driver and an OVR staff member, and references Numbered Memo 10-100.02. The document also includes a standard statement indicating auxiliary aids and services are available to individuals with disabilities, and affirms the organization's commitment to being an Equal Opportunity Employer/Program.
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Text version
OVR-142
7/10 ALL Department of Labor & Industry
Office of Vocational Rehabilitation
I, (Print name.)
agree that I will not solicit, disclose, receive or make use of any information concerning, persons applying for or receiving vocational rehabilitation services, directly or indirectly derived from the execution of my duties as a Driver pursuant to contract # .
I understand that I must not divulge this information to any person or entity. Breach of this confidentiality may result in termination of the contract.
Further, I agree to maintain the confidentiality of information obtained in the course of my duties with respect to all matters relating to employees and customers of the Pennsylvania Office of Vocational Rehabilitation, whether such information is written, verbal or observed.
Driver Signature Date
OVR Staff Signature Date
Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity Employer/Program
Refers to Numbered Memo 10-100.02
CONFIDENTIALITY
CONFIDENTIALITY
Sherrie Bruegman
OVR-142
7/10
ALL
Department of Labor & Industry Office of Vocational Rehabilitation I, (Print name.)
agree that I will not solicit, disclose, receive or make use of any information concerning, persons applying for or receiving vocational rehabilitation services, directly or indirectly derived from the execution of my duties as a Driver pursuant to contract # I understand that I must not divulge this information to any person or entity. Breach of this confidentiality may result in termination of the contract.
Further, I agree to maintain the confidentiality of information obtained in the course of my duties with respect to all matters relating to employees and customers of the Pennsylvania Office of Vocational Rehabilitation, whether such information is written, verbal or observed.
Driver Signature Date OVR Staff Signature Date Auxiliary aids and services are available upon request to individuals with disabilities. Equal Opportunity Employer/Program Refers to Numbered Memo 10-100.02
CONFIDENTIALITY
| Print or Type the driver's name.: |
| Type or Print the Contract number.: |
| Resets the form: |
| Prints the form.: |
File details come from the government source that posted it. Updated .