DATE IF14-17(i
Approved For Release 2001/04/02 : C IA-RDP96-00788 ROO f2OW610071 -1
CONSULTANT SECURITY AGREEMENT
Ach y Rd & Rd 19 , understand that the highly sensitive
and classified information I have, or am about to receive as part of an
official U.S. Government program belongs to the U.S. Government. I un.der-
stand that the disclosure of this information is punishable under Title 18,
Section 798, U.S.C., "msclosure of Classified Information," June 1948, as
amended.
I do solemnly swear that I will never divulge, publish, or reveal by word,
conduct, or by any other means such classified information or knowledge,
except in tbe performance of my official duties, and as specifically
authorized in writing in each case by the appropriate agency of the U.S.
Government.
I understand that no change in my assignment or employment will relieve me
of my obligation under this agreement and that the provisions of this agree-
ment will remain binding upon me even after the termination of my services
with the U.S. Government.
I take this obligation of my own free will, without any mental reservation
or purpose of evasion.
                   DATA REQUIRED BY THE PRIVACY ACT OF 1974
                                (5 U.S.C. 552a)
1. Authority: National Records Act, 44 U.S.C. 3102; E.O. 9397, Numbering
System for Federal Accounts Relating to Individual Personnel, November 22,
1943.
2. Principal Purpose: To maintain a record of those individuals who have
or have had access to classified information through the use of their name
and/or Social Security Number.
3. Routine Uses: The Social Security Number is to be used to identify the
individual, and the information is to be retained strictly within the Program.
4. Mandatory of Voluntary Disclosure: Information is disclosed on a
voluntary basis, but withholding information will render it impossible to
grant an individual access to or participation in the Program.
WITNESS:
NAME
SGFOIA3
SGFOIA3
Approved For Release 2001/04/02 CIA-RDP96-00788ROol 200010071 -1