General Statement of Confidentiality “*” indicates required fields URL Optional OptionalThis field is for validation purposes and should be left unchanged.Your Name* First Last Job Title*Service Request Number Optional OptionalIf you’ve been given an SRV number, please input this here. This field is hidden when viewing the formDate* DD slash MM slash YYYY This form may be submitted where proof that a Trust contract has been signed is not readily available. It is only intended as a substitute for the confidentiality agreement with a Trust contract of employment. In accordance with the NHS Confidentiality Code of Practice and the UK GDPR/DPA18 I am required to ensure the confidentiality of all information, irrespective of its format, that I may have access to whilst working within the Trust. Under no circumstances will I divulge or pass any of this information on to any unauthorised persons. This information includes any: Person Identifiable Data (to include Patient and Staff data) Disciplinary, grievance or other investigation reports and associated documents Corporate, financially or contractually sensitive information Time embargoed informationI understand and agree, unless otherwise stated, all information on the Trust’s ICT Systems is, and remains, the property of the Trust, which asserts all of its rights in respect of this information.I understand and agree to ensure that all information remains on Trust ICT Systems, and is not transferred to any computers not owned by the Trust unless I have the appropriate authorisation.I understand and agree to comply with all of the policies as issued by the Trust in respect of the use of their ICT systems, and that these policies are available on the Trust’s Intranet.I understand and agree that any account or access allocated to me is for my use only and I will not share it, any password or access token with any other person, or allow any other person to use it; nor will I use any other person’s account or access rights. Access to ICT systems is granted on a “need to know” basis and I will not attempt to circumvent any security devices to gain access to information to which I have not been authorised.A breach of, or refusal to comply with Trust policy, is a disciplinary offence, which may lead to disciplinary action, up to and including, in appropriate circumstances, dismissal without notice. Any such disciplinary action is to be taken in accordance with the current Trust disciplinary policy. In certain cases, the Trust may refer any incident to the NHS Counter Fraud Services and or the Police for formal criminal investigation. Additionally, the use of any, or all, ICT service(s) may be suspended pending any investigation into an alleged misuse or breach of Trust policy. Signature*Sign and complete with your finger or mouse.