04 Attachment B - OVR Contractor Personnel Confidentiality Form.pdf
PDF 587 KB Posted
- Attached to
- Erie OVR Enhanced Driving/Anc Svcs
- Solicitation number
- 6100065978
- Issued by
- Erie County, Pennsylvania
About this file
This is a Confidentiality Form (OVR-142) issued by the Pennsylvania Department of Labor & Industry, Office of Vocational Rehabilitation (OVR), for use by contractor personnel providing driving services under the Erie OVR Enhanced Driving and Ancillary Services contract. The form serves as a binding agreement requiring drivers to maintain strict confidentiality regarding all information obtained during the execution of their duties, specifically concerning persons applying for or receiving vocational rehabilitation services. Drivers must commit to not soliciting, disclosing, receiving, or making use of any confidential information derived from their work, whether such information is written, verbal, or observed. The form requires the signature of both the driver and an OVR staff member to acknowledge understanding and acceptance of these confidentiality obligations.
Breach of the confidentiality agreement outlined in this form may result in immediate termination of the contract. The form is applicable to contractors serving the OVR Erie District, which covers Clarion, Crawford, Erie, Forest, Venango, and Warren counties in Pennsylvania. The document emphasizes that confidentiality obligations extend to all matters relating to employees and customers of the Pennsylvania Office of Vocational Rehabilitation, establishing a comprehensive restriction on information sharing for all contractor personnel involved in transportation services for individuals with disabilities.
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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 .