04 Attachment B - OVR Contractor Personnel Confidentiality Form.pdf
PDF 587 KB Posted
- Attached to
- Johnstown OVR Enhanced Driving/Anc Svcs
- Solicitation number
- 6100065977
- Issued by
- Carbon 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), applicable to contractor personnel performing driver services under the Johnstown OVR Enhanced Driving and Ancillary Services contract. The form requires all drivers to sign a confidentiality agreement acknowledging their obligation to protect sensitive information regarding persons applying for or receiving vocational rehabilitation services. Drivers must commit to maintaining strict confidentiality of all written, verbal, and observed information relating to OVR employees and customers encountered during the performance of their duties. The form includes a template for documenting the driver's name, contract number, and signatures from both the driver and OVR staff, along with verification from an OVR representative.
Breach of the confidentiality agreement may result in contract termination. The form emphasizes that drivers may not solicit, disclose, receive, or make use of any confidential information derived directly or indirectly from the execution of their driver duties. This requirement extends to all matters relating to OVR employees and customers regardless of the form or method in which the information is obtained. The document references Pennsylvania's Equal Opportunity Employer/Program policy and notes that auxiliary aids and services are available upon request to 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 .