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Confidentiality Statement:
I acknowledge and understand that I may have access to confidential information regarding [employees, students, patients, inmates, the public]. In addition, I acknowledge and understand that I may have access to proprietary or other confidential information business information belonging to Wytheville Community College. Therefore, except as required by law, I agree that I will not:
Access data that is unrelated to my job duties at Wytheville Community College
Disclose to any other person, or allow any other person access to, any information related to Wytheville Community College that is proprietary or confidential and/or pertains to [employees, students, patients, inmates, the public]. Disclosure of information includes, but is not limited to, verbal discussions, FAX transmissions, electronic mail messages, voice mail communication, written documentation, "loaning" computer access codes, and/or another transmission or sharing data.
I understand that Wytheville Community College and its [employees, students, patients, inmates, public], staff or others may suffer irreparable harm by disclosure of proprietary or confidential information and that Wytheville Community College may seek legal remedies available to it should such disclosure occur. Further, I understand that violations of this agreement may result in disciplinary action, up to and including, my termination of employment.
Employee Signature Date
Annual Requirements:
Activity Current? If so, date completed?
Required In-Service/MOAT or other training FORMCHECKBOX Yes Date FORMCHECKBOX No FORMCHECKBOX N/A
Valid Licensure/Certification/Registration FORMCHECKBOX Yes Date FORMCHECKBOX No FORMCHECKBOX N/A
Employee Health Update FORMCHECKBOX Yes Date FORMCHECKBOX No FORMCHECKBOX N/A
Essential Job Requirements (Indicate by E = Essential, M = marginal, or N/A)
Physical Demands and Activities:
_________ Light Lifting <20 lbs. Standing ________ Sitting _________ Bending _____
_________ Moderate Lifting 20-50 lbs. Lifting ________ Walking _________ Climbing _____
_________ Heavy Lifting >50 lbs. Reaching ________ Repetitive Motion ______
_________ Pushing/pulling Other
Emotional Demands: Mental/Sensory Demands:
_________Fast pace ________ Avg. pace Memory ______ Reasoning ______ Hearing _____
_________Multiple priorities Reading ______ Analyzing ______ Logic _____
_________Intense customer interaction Verbal Communication _____
_________Multiple stimuli Written Communication _____
_________Frequent Change Other
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