WISCONSIN DEPARTMENT OF JUSTICE
(Rev. 5/2017)

Confidentiality and Non-Disclosure Acknowledgement
This applies to all Wisconsin Department of Justice (DOJ) permanent employees, limited term employees,
contractors, interns, externs, and law enforcement partners, who will be referred to as “employees1”
throughout this Acknowledgement.
As a DOJ employee, I have a legal responsibility to protect the security of all confidential information to
which I have access in carrying out my job duties. Confidential information may be protected by state and
federal laws and by policies of the DOJ. Confidential information includes, but is not limited to: Criminal
Justice Information (CJI), Personally Identifiable Information (PII), Protected Health Information (PHI),
intellectual property, and Third Party Proprietary Information. It may be from any source or in any form
(oral, written, or electronic).
I will conduct myself in strict conformance to all applicable laws and DOJ policies governing confidential
information. This means, among other things, that:
1) I will take all reasonable precautions to safeguard confidential information such as:
a) using lockable file cabinets and / or desk drawers;
b) securing data disks, tapes or CDs;
c) ensuring emails containing confidential information are encrypted or secured if printed;
d) logging off or locking my workstation before leaving it unattended;
e) safeguarding and not disclosing computer / network user IDs and passwords to anyone;
f)

immediately changing my password and informing my supervisor if the confidentiality of my
password has been compromised;

g) not requesting access to or using any other person’s passwords or access codes; and,
h) making efforts to avoid conversations from being overheard by non-DOJ employees.
2) I will not in any way access, use, divulge, copy, share, sell, lend, review, alter, or destroy any
confidential information except as properly and clearly authorized within the scope of my job and all
applicable DOJ policies, procedures and laws.
3) If applicable, I will adhere to professional ethical standards.
4) I will not ask others to access or disclose confidential information to me, unless I have a legitimate,
work-related reason to have that information.
5) I will promptly report to my supervisor any conditions or activities that I reasonably believe may
potentially compromise confidential information.
6) Upon separation from my employment or association with DOJ: I will ensure that any confidential
information I may possess (including notes, copies, documents, and information on my personal
computer) is returned to DOJ; I will not take with me any confidential information, nor will I disclose
confidential information, whether written, oral, or otherwise.
7) At my supervisor’s direction, I will participate in training to fully understand all confidentiality and
privacy requirements that apply to my work.
By my signature below, I confirm that I have read and understand the terms and conditions of this Confidentiality
and Non-Disclosure Acknowledgement, and I accept responsibility to safeguard the privacy and confidentiality of
all information I manage or become privy to in the course of my employment. I also understand a copy will be
placed in my personnel file.
NAME (PRINT)

POSITION

SIGNATURE

DATE SIGNED

Please submit this signed statement to DOJ Human Resources.
The use of the term “employees” is not a determination that all permanent employees, limited term employees, contractors, interns,
externs, and law enforcement partners meet the definition of a state agent, employee, or officer under Wis. Stats. 893.82 and 895.46.
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