Document ID No.

 : FR-SHS-003

CONFIDENTIALITY AGREEMENT FOR SHS

WORK IMMERSION (SHSWI) TRAINEES Revision No.: 00

Date Effective:
September 2022

First Name Middle Name Last Name

ELYZIA NAZARENE BELCHEZ
Department/Institution
engaged with:
Inclusive dates of training: From: To:

In connection with my engagement as SHSWI Trainee, I agree to the following:

 I understand that confidential information may include, but is not limited to, the following:
trade secrets, proprietary information, customer information, customer lists, methods,
plans, documents, data, drawings, manuals, notebooks, reports, models, inventions,
formulas, processes, software, information systems, contracts, negotiations, strategic
planning, proposals, business alliances, and training materials.
 I understand that in the course of my Work Immersion experience I may have access to and
be involved in the processing of verbal, written, computer generated, computer accessed,
filmed, and/or recorded information related to clients, employees, and staff or the
organization or business.
 I understand that I am required to maintain confidentiality of this direct or indirect
information at all times, both during and after my SHSWI experience.
 I agree that I will not at any time, both during and after my SHSWI experience, communicate
or disclose confidential information to any person, corporation, or entity.
 I understand that any breach of confidentiality may result in disciplinary action, including
termination from the SHSWI Program, with failing evaluation, or legal action.
 I certify by my signature that I acknowledge being informed of the confidentiality policy
concerning confidential information or its treatment.
 I agree to adhere to and uphold the private and privileged information therein.

Signature over Printed Name Date

SHSWI Trainee

Noted by:

Signature over Printed Name Date

SHSWI Adviser

Signature over Printed Name Date

Training Supervisor

Note: The SHSWI trainee must sign this document in the presence of the SHSWI Adviser and
Training Supervisor.
A copy of this agreement must be filed in the trainee’s SHSWI Program folder in addition to
providing a copy to the APL Officer.