Document Type: 
Document Number (FOIA) /ESDN (CREST): 
Release Decision: 
Original Classification: 
Document Page Count: 
Document Creation Date: 
June 22, 2015
Document Release Date: 
November 14, 2008
Sequence Number: 
Case Number: 
Publication Date: 
July 11, 1984
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APPROVED FOR RELEASE DATE: 03-Sep-2008 (b)(2) (b)(3) (b)(6) This signed statement serves to acknowledge that I have been informed that the CIA cannot condone involvement by an employee or assignee with illegal drugs. I understand that if an employee or assignee is determined to be involved in the illegal possession, use, transport, transfer, sale, cultivation, processing or manufacturing of hallucinogens, narcotics, drugs or other materials and chemical compounds identified and listed in the Controlled Substance Act of 1970, as amended, appropriate administrative action will be taken. Such action may result in suspension and, in certain cases, including but not limited to the above-described involvement with "hard" drugs, dismissal from the CIA. I have been informed, moreover, that the Agency is obligated to report to the Department of Justice, for possible prosecution, certain drug-related in- fractions by an employee. I have also been informed that further employee security processing and procedures may be required if incidents of illegal drug involvement later come to the attention of the CIA. I, further, have been informed that any such illegal drug involvement during any later period of nonemployment or disassociation with the CIA may have a significant effect at the time of any consideration of my re-employment or association with the Agency. PRIVACY ACT NOTIFICATION: The Privacy Act, Public Law 93-579, requires that Federal agencies inform individuals when they are asked to provide their Social Security Number (SSN) whether the disclosure is mandatory or voluntary, by what authority such number is solicited, and what uses will be made of the SSN. Disclosure by you of your SSN is voluntary. The authority for this solicitation is Executive Order 9397. The SSN is used as a positive identifier. SOLETE PREVIOUS ITIONS