Part One (Please Print)
Employee Name:__________________________________________ W#: ___________
(Last) (First) (Middle Initial)
E-mail:_________________________________ WSU Extension:__________________
Does this person replace someone? (Y or N)___ If yes, who _______________________
Faculty __ Staff __ Student __ Dept. ___________________ Cost Code:__________
Department Access? (Y or N) ____ Continuing Ed. Access? (Y or N) ______
Immediate Supervisor: ________________________________ Date:_______________
(Signature Required)
Part Two (Please Read and Sign Below)
1. For purposes of the Agreement, “confidential information” is defined as information
disclosed to me, accessed by me, or otherwise known to me as a consequence of my
employment. It includes but is not limited to information accessible through the Weber
State University LYNX system.
2. Along with the right to access transcripts/confidential records of students at Weber
State University (WSU) comes the responsibility to maintain the privacy rights of
students as outlined in the Family Educational Rights and Privacy Act (FERPA). I agree
to comply with FERPA by not disclosing personally identifiable information about students
to unauthorized third parties without the written consent of the student, except as
permitted by law or federal regulations. I further agree to consult with my supervisor,
the University Registrar, or University Legal Counsel if I am uncertain about the
appropriate response.
3. During my employment and after the termination of my employment, I will hold
confidential information of the University in trust and confidence, and will not use or
disclose it or any embodiment thereof, directly or indirectly, except as may be necessary
in the performance of my duties for the University. I understand that unauthorized
disclosure could be highly damaging to the University, its faculty, staff, students, donors,
or others.
4. I will not remove materials containing confidential information from Weber State
University, unless authorized to do so by my supervisor. Any and all such materials are
the property of the University. Upon termination of any assignment or as requested by
my supervisor, I will return all such materials and copies thereof.
5. I agree to safeguard personally-identifiable data, the official records in the custody of
the University, and the means and conditions of custodial security, and I agree to keep
such information and means secure and strictly confidential at all times, whether on or
off duty.
I acknowledge that I fully understand that the intentional disclosure by me of confidential information to any unauthorized person could subject me to criminal and civil penalties imposed by law. I further acknowledge that such willful or unauthorized disclosure also violates University policy and could constitute just cause for disciplinary action including termination of my employment regardless of whether criminal or civil penalties are imposed. Violations by Student employees will be forwarded to the Dean of Students for disciplinary action.
Employee Name: _________________________________ Date:__________________
(Please Print)
Employee Signature: ______________________________________________________