CONFIDENTIALITY AND CONFLICT OF INTEREST AGREEMENT

Community Link ABQ (CLABQ)

CONFLICTS OF INTEREST ACKNOWLEDGMENT AND DISCLOSURE

If at any time following the submission of this form I become aware of any actual or potential conflicts of interest between what I am asked to do at CLABQ and other commitments I have, or if the information provided below becomes inaccurate or incomplete, I will promptly notify the CLABQ Executive Director or a member of the Board of Directors.

CONFIDENTIALITY OF INFORMATION

.

I may be exposed to sensitive information while working with Community Link ABQ.  This could be Social Security Numbers, sensitive medical information or any other personal information about people associated with CLABQ.  I will not disclose this information to anyone outside CLABQ and only to CLABQ staff in the performance of my duties there.  

I will comply with the Confidentiality and Conflict of Interest Policy as posted on the CLABQ.ORG website.

I will not put any sensitive information on personnel in the CLABQ Volunteer Database.

I acknowledge and agree to the information above.  I will direct any questions to the CLABQ Executive Director.

Signature: __________________________________

Name: (Please Print)   _____________________________________

Date: ______________________________________

1/10/2017   Version 1