ssf4087.pdf

DEPARTMENT OF HOMELAND SECURITY

United States Secret Service

NON-USSS EMPLOYEE CERTIFICATION

Instructions

The SAIC or Division Chief will ensure that all summer student assistants, interns, Foreign Service Nationals (FSNs), law enforcement partners and task force members, other government agency personnel, and contractors sign this certificate acknowledging they have read and agree to abide by the policies listed below.

For all individuals, certification will take place on their "Enter on Duty" date and annually thereafter.

Contractor certification will be accomplished annually. A copy of this form will be placed in the COTR's folder and retained in the contract files pursuant to record retention schedules for contract files. The individual will sign and date this form each year to signify that he or she is aware of the applicable policy and understands that he or she is expected to comply with it.

Information Technology (IT) General Rules of Behavior (IRM-10(03))

Social Media Standards of Conduct (PAF-08(02))

Date

Name of Non-USSS Employee (Print):

Organization:

Type of Associate:

(Summer Student Assistant, Intern, FSN, Contractor, Law Enforcement Partner, Task Force Member, Other Government Agency Personnel, Other - specify)

USSS Point of Contact:

(COTR, SAIC, Division Chief)

Non-USSS Employee Certification

I have reviewed the standards and policies of the Secret Service as outlined above and I agree to comply with them.

Unauthorized use of information technology systems, or social media may result in criminal, civil and/or administrative penalties.

Signature Date

1.

2.

3.

4.

SSF 4087 (Rev. 2/2012) Page 1 of 1