Free confidentiality statement 33Free confidentiality statement 33
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EMPLOYEE CONFIDENTIALITY STATEMENT
FACULTY/STAFF

INSTRUCTIONS:
1. Please print or type the information in the top portion of this document.
2. Read the Confidentiality Statement and the “Information Practices Act of 1977” and
“Title V, California Code of Regulations” sections on the reverse side.
3. Sign this statement acknowledging that you have read and understand the terms and conditions stated below.
4. Return the form to Human Resources, HRIS at Mail Drop 8229.
5. Note: Employees will not be given access to administrative computing systems until this form is signed and
reviewed by Human Resources.
CSUN ID:
Job Title:

Employee Name:
Supervisor:

Department:

Mail Drop:

Confidentiality statement for employee access to university data systems containing personal, academic, or financial
information about students, faculty, staff or alumni:
I certify that I have received training on the appended state and federal laws and University policies that govern access
to and use of informat