Confidentiality Form

Posted on by admin | in Background Check



Confidential information/Nondisclosure: Any information (written/verbal) that is discovered during the course of employment shall not be released to a third party,
except required by law, concerning the child, children, parents or other members of the immediate family relating to family customs, childcare procedures, child development,
family interaction or any other information that is discovered during employment by employee.

WHEREAS, _________________________agrees to furnish _____________________ certain confidential information relating to:

WHEREAS, _____________________ agrees to review, examine, inspect or obtain such confidential information only for the purposes described above,
and to otherwise hold such information confidential pursuant to the terms of this Agreement.

BE IT KNOWN, that ___________________________________ has or shall furnish to ________________certain confidential
information and may further allow _______________________the right to discuss or interview representatives of ______________________________________ on the following conditions:

1. _____________________ agrees to hold confidential or family information (“confidential information”)
in trust and confidence and agrees that it shall be used only for the contemplated purposes, shall not be used for any other purpose, or disclosed to any third party.

2. No copies will be made or retained of any written information, family photos, child photos etc. supplied without the permission of _____________________.

3. At the conclusion of any discussions, or upon demand by _________________________, all confidential information, including, written notes, family photographs,
memoranda or notes taken shall be returned to ___________________________and not released to any third parties

4. Any Confidential information shall not be disclosed to any employee, media or third party unless they agree to execute and be bound by the terms of this Agreement,
and have been approved by _______________________. This includes family issues, events, problems etc.

5. This Agreement and its validity, construction and effect shall be governed by the laws of ____________ (state)


Date: _________________________

By:     _________________________     Witness: ___________________________

Title: _________________________

By:     _________________________

Title:  _________________________

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