The below information is required and will be used for your application and background check.
Education and Work Experience
Skills and Talents
Days and Times Most Often Available
Person to Notify In Case of Emergency
Volunteer Time Documentation
Confidentiality Agreement Information
As an employee, volunteer, student, or other person affiliated with CHI St.
Gabriel's Health, you may have access to what this agreement refers to as
"Confidential Information.” The purpose of this agreement is to help you
understand your responsibility regarding confidential information.
Confidential information includes patient, employee, volunteer, student,
financial information, and other information proprietary to CHI St. Gabriel's
Health facilities or persons. You may learn or have access to some or all of
this confidential information through a computer system or through your
activities at CHI St. Gabriel's Health.
You are required to conduct yourself in a manner which is consistent with CHI
St. Gabriel's Health Policies and Procedures. By reading and signing this
agreement, you agree to the following:
- I will use confidential information only as needed to perform my
- I will only access confidential information for which I have a need to
- I will not in any way divulge, copy, release, sell, lend, review, alter,
or destroy confidential information except as properly authorized within the
scope of my assigned duties affiliated with CHI St. Gabriel's Health, and
will be held accountable for the misuse or wrongful disclosure thereof.
- I will not misuse confidential information or carelessly care for
- I will report any activity by individuals whose actions compromise the
confidentiality of information to either my department management or the CHI
St. Gabriel's Health Information Security Administrator.
- My obligation under this agreement will continue after termination of my
employment, voluntary association, or student experience.
- At all times during my affiliation with CHI St. Gabriel's Health, I will
safeguard and retain the confidentiality of confidential information. I
understand that I do not have right or ownership interest in any access,
password, or other authorization to confidential information.
- I will safeguard and not disclose my password or any other authorization
which allows access to confidential information.
- I will be accountable for the misuse or wrongful disclosure of
confidential information obtained through the use of my sign-on and
I acknowledge that I understand and agree that if I should not abide by this
agreement, disciplinary actions up to and including termination of my
affiliation with CHI St. Gabriel's Health, will result.