SECRECY AGREEMENT

• Document Type: CREST
• Collection: General CIA Records
• Document Number (FOIA) /ESDN (CREST): CIA-RDP87B01034R000600160001-2
• Release Decision: RIFPUB
• Original Classification: K
• Document Page Count: 7
• Document Creation Date: December 12, 2016
• Document Release Date: May 23, 2002
• Sequence Number: 1
• Content Type: FORM

S C'REFC: y' AC:REEMENT
Approved For Release X61/06/19 : CIA-RDP87B01034R000600160001-2
1. 1, (print full name), hereby agree to accept as a prior condition of my
being employed by, or otherwise retained to perform services for, the Central Intelligence Agency, or for staff elements of
the Office of the Director of Central Intelligence (hereinafter collectively referred to as the "Central Intelligence Agency"),
the obligations contained in this agreement.
2. 1 understand that in the course of my employment or other service with the Central Intelligence Agency I may be
given access to information which is classified in accordance with the standards set forth in Executive Order 12065 as
amended or superseded, or other applicable Executive Order, and other information which, if disclosed in an unauthorized
manner, would jeopardize foreign intelligence activities of the United States Government. I accept that by being granted
access to such information I will be placed in a position of special confidence and trust and become obligated to protect the
information from unauthorized disclosure.
3. In consideration for being employed or otherwise retained to provide services to the Central Intelligence Agency, I
hereby agree that I will never disclose in any form or any manner any of the following categories of information or
materials, to any person not authorized by the Central Intelligence Agency to receive them:
a. information which is classified pursuant to Executive Order and which I have obtained during the course of my
employment or other service with the Central Intelligence Agency;
b. information, or materials which reveal information, classifiable pursuant to Executive Order and obtained by me
in the course of my employment or other service with the Central Intelligence Agency but which, because of
operational circumstance or oversight, is not formally marked as classified in accordance with such Executive Order
and which I know or have reason to know has not been publicly acknowledged by the Agency;
c. information obtained by me in the course of my employment or other service with the Central Intelligence
Agency that identifies any person or organization that presently has or formerly has had a relationship with a United
States foreign intelligence organization, which relationship the United States Government has taken affirmative
measures to conceal.
4. 1 understand that the burden will be upon me to learn whether information or materials within my control are
considered by the Central Intelligence Agency to fit the descriptions set forth in paragraph 3, and whom the Agency has
authorized to receive it.
5. As a further condition of the special confidence and trust reposed in me by the Central Intelligence Agency, I
hereby agree to submit for review by the Central Intelligence Agency all information or materials including works of fiction
which contain any mention of intelligence data or activities, or contain data which may be based upon information
classified pursuant to Executive Order, which I contemplate disclosing publicly or which I have actually prepared for public
disclosure, either during my employment or other service with the Central Intelligence Agency or at any time thereafter,
prior to discussing it with or showing it to anyone who is not authorized to have access to it. I further agree that I will not
take any steps toward public disclosure until I have received written permission to do so from the Central Intelligence
Agency.
6. 1 understand that the purpose of the review described in paragraph 5 is to give the Central Intelligence Agency an
opportunity to determine whether the information or materials which I contemplate disclosing publicly contain any
information which I have agreed not to disclose. I further understand that the Agency will act upon the materials I submit
and make a response to me within a reasonable time.
7. 1 understand that all information or materials which I may acquire in the course of my employment or other service
with the Central Intelligence Agency which fit the descriptions set out in paragraph 3 of this agreement are and will remain
the property of the United States Government. I agree to surrender all materials reflecting such information which may
have come into my possession or for which I am responsible because of my employment or other service with the Central
Intelligence Agency, upon demand by an appropriate official of the Central Intelligence Agency, or upon the conclusion of
my employment or other service with the Central Intelligence Agency.
8. 1 agree to notify the Central Intelligence Agency immediately in the event that I am called upon by judicial or
congressional authorities to testify about, or provide, information which I have agreed herein not to disclose.
9. 1 understand that nothing contained in this agreement prohibits me from. reporting intelligence activities which I
consider to be unlawful or improper directly to the Intelligence Oversight Board established by the President or to any
successor body which the President may establish. I recognize that there are also established procedures for bringing such
matters to the attention of the Agency's Inspector General or to the Director of Central Intelligence. I further understand
that any information which I may report to the Intelligence Oversight Board continues to be subject to this agreement for all
other purposes and that such reporting does not constitute public disclosure or declassification of that information.
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10. 1 understand that any breach of this agreement by me may result in the Central Intelligence Agency taking
administrative action against me. which can include temporary loss of pay or termination of my employment or other
service with the Central Intelligence Agency. I also understand that if I violate the terms of this agreement, the United
States Government may institute a civil proceeding to seek compensatory damages or other appropriate relief. Further, I
understand that the disclosure of information which I have agreed herein not to disclose can, in some circumstances,
constitute a criminal offense.
11. 1 understand that the United States Government may, prior to any unauthorized disclosure which is threatened by
me, choose to apply to any appropriate court for an order enforcing this agreement. Nothing in this agreement constitutes a
waiver on the part of the United States to institute a civil or criminal proceeding for any breach of this agreement by me.
Nothing in this agreement constitutes a waiver on my part of any possible defenses I may have in connection with either
civil or criminal proceedings which may be brought against me.
12. In addition to any other remedy to which the United States Government may become entitled, I hereby assign to
the United States Government all rights, title, and interest in any and all royalties, remunerations, and emoluments that
have resulted or will result or may result from any divulgence, publication or revelation of information by me which is
carried out in breach of paragraph 5 of this agreement or which involves information prohibited from disclosure by the
terms of this agreement.
13. 1 understand and accept that, unless I am provided a written release from this agreement or any portion of it by the
Director of Central Intelligence or the Director's representative, all the conditions and obligations accepted by me in this
agreement apply both during my employment or other service with the Central Intelligence Agency, and at all times
thereafter.
14. 1 understand that the purpose of this agreement is to implement the responsibilities of the Director of Central
Intelligence, particularly the responsibility to protect intelligence sources and methods, as specified in the National Security
Act of 1947, as amended.
15. In any civil action which may be brought by the United States Government for breach of this agreement, I
understand and agree that the law of the Commonwealth of Virginia shall govern the interpretation of this agreement.
16. Each of the numbered paragraphs and lettered subparagraphs of this agreement is severable. If a court should find
any of the paragraphs or subparagraphs of this agreement to be unenforceable, I understand that all remaining provisions
will continue in full force.
17. 1 make this agreement in good faith, and with no purpose of evasion.
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Signature
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Date
The execution of this agreement was witnessed by the undersigned, who accepted it on behalf of the Central Intelligence
Agency as a prior condition of the employment or other service of the person whose signature appears above.
WITNESS AND ACCEPTANCE:
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Signature
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Printed Name
xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx
Date Approved For Release 2002/06/19 : CIA-RDP87BO1034R000600160001-2
 Approved For Release 2002/06/19: CIA-RDP87B01034R000600160001-2
NONDISCLOSURE AGREEMENT
SENSITIVE COMPARTMENTED INFORMATION
1. I, (print full name) hereby acknowledge
that I have received a security indoctrination concerning the nature and protection
of certain classified information and intelligence sources and methods, which are
known as Sensitive Compartmented Information, designated as: _
t" "IN
and hereinafter referred to as "the-designated-Sensitive Compartmented Information."
2. I have been advised tha direct or indirect unauthorized disclosure,
unauthorized retention or negligentandling,'of/the designated sensitive
%
Compartmented Information by me could\cause'irreparable injury to the
United States and be used to advantage by a foreign nation.
se's
3. I have been advised of the urity handling, storage, and transmittal
procedures which are`.Q;\be-used to protect the designated Sensitive -Compartmented
Information, d the procedures to be followed in ascertaining.whether-gther persons
to whom I contemplat'e4ieclpsing this information have beenapproved~for access
to it, and I ui~dersta -and:-these rocedures. 'y, -'~
11 4. In consideratign of eing granted, a cress to fie designated Sensitive
~
Compartmented Information, \pledga that-T-wi ~,,never vulge such information,
out prior written `authorization rom an''spprop iatte
Sensitive Compartme4ed Informs io by y me may be-ibstantial violation- ef -this
agreement, arid/ ay result in th e termination of my, access. In,addition,~iT4 ave
been advised i6t-any ch un_authprized disclosure by me may constitute viola-
tions- of=-O 11tec1 /ratessuivil or criminal-a.aws including, as to the letter.-- the
~il~e
794, s~ 8f i
provisio ns\of.ecton 73w,.
apply,
mented
a. moerstano ana agree
prior-~to cagy unautho zed
'
Inf ortipzf
'by
outs ic`r& - r9A i,C. ng~suc ? A insure.
'ff-apt_ ion wh 'k o
At ~b \~rc u,ht b ?he United States Government
for breach of this agreemen ,, the//~,,ai /the\D3s ct 61-A uthbia shall govern
;en - advisea *hat the action can
the interpretation of this ~greem ''t 1'~I1r ve~~b~
be brought against me in any of the seNer, \p ?Aopriate United States District
Courts where the United States Government~may.'elect to file the action. Court
costs, and reasonable attorneys fees incurred by the United States Government
may be assessed against me if I lose such action.
8. I hereby assign to the United States Government all rights, title and
interest, and all royalties, remunerations, and emoluments that have resulted,
will result or may result from any such disclosure, publication or revelation
not consistent with the terms of this agreement.
Approved For Release 2002/06/19 : CIA-RDP87B01034R000600160001-2
FORM 4066 ' $t r~cviou,
5.79
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any unauthorized
United States Co-de'~;fand of
aY [se{lunited states Government may choose
fficial' of tie United States
isclosur 'of the designated
F
 Appr,
SECRET
(WR.^ rluea In)
I understand that no change in my employment status or relationship fith"-tke United
I have been advised of the procedures to follow in order to determine the identity of
individuals who have been approved for access to this Project, the current estimate of hazard
involved In travel to a foreign area or to resolve any other question which may arise under
.this Agreement.
PRO)ECTs,
NAME OP WITNESS (Type of Print)
NAME (Type or Print)
SIGNATURE OP WITNESS
SIQNATLM. E - ?
REMARKS -
NAME i ADDRESS OF AFFILIATION
PHASE -
CIA
DCI
SOCIAL SECURITY'
DATE OF BIRTH
DATE
PLACE OF BIRTH
24 October 1973
'The slpno-er aI* .Id plod ids inhiels shot, eecA 'Proie6 name.
Approved For Release 2002/06/19 : CIA-RDP87BO1034R000600160001-2
SECRET
 Approved For Release 2002/06/19': 61E 7B01034R000600160001-2
(WM' ruled 1w)
SPECIAL PROJECT SECRECY AGREEMENT
acknowledge that 1 have been indoctrinated in the Project identified below and thus
._~
dare received highly classified information relating to United States intelligence collection
1 om aware that the unauthorized disclosure or negligent handling of such in-
..... ?.. - . s,~ivilies.
f emotion could seriously affect the national defense and that the transmission or revelation
ld
b
su
ject me to prosecution under the Es.
of such information to unauthorized persons cou
d 794
).
000090 Laws (Title IS, u.>;-,% Sections 793 an
Lion and will execute a Termination Secrecy Agreement upon notification that such is re-
Awri-CL
I have been informed that approval for access to Project information may only be granted
by Project Headquarters. I have also been informed that extraordinary security measures
.and controls hoye... . been established to protect Project information and that .access to such
information is restricted to those who "must know" based upon their present position or func-
?-iional use. I agree -Jo advise appropriate authorities of any change in my position or func-
codewords, and admits to the ultimate intelligence application of the Project, is given only
to those individuals who have been specifically approved for the above identified Project at
the highest -level and that this type information may not be divulged to individuals with lesser
levels of access.
am-aware that travel to certain hazardous.or denied-areas of the world such as the
USSR,,.Communist China, and Sino-Soviet satellite areas may constitute unacceptable se-
curity risk and I agree, until formally relieved of this requirement, to 'request authorization
from Project Headquarters- prior 4o--undertaking such travel. 7T.'.
Having reviewed the above security requirements, I pledge -that 1 will never -publish or
reveal, by any, means,. classified. project information to unauthorized. persons. Along with
this pledge I recognize and accept the fact that 1 have a personal and individual responsi-
bility for the protection of all such information in my possession no matter where generated
nor how acquired and agree to abide by the security requirements and regulations estab-
rished for the Project.
R RfoLed Fo
SECRET
lease 2002/06/19: CIA-RDP87B01034
 SECRET %
11
a-I FFDiA?901614R000600160001-2
Approved For Release 2002/06/i9 wh: CIAn
AGREEMENT,
. I'' E
I have read and fully understand the briefing statement made available
to me regarding . By virtue of this briefing, I acknowled
that I have been the recipient of information relating to a highly classified
program of interest to the United States Government.
I have been advised that due to the nature of this activity and the maximul
Presidential priority placed upon security accomplishment, extreme security
measures and controls will be extended to protect program information. There
fore, access to the actual program and related information is strictly
limited, and approval for access is grantxd only when it can be demonstrated
that the individual will directly further the program and/or provide needed
support. -
In order to avoid any possible misunderstanding of the security factors
involved, everyone cleared for access to receives this
briefing. information will not be disseminated without
the prior approval of Project Headquarters and there is to be no reference to
with other than - cleared personnel.
Having reviewed the above. I hereby accept the responsibility to handle
information concerning . in accord with the security measures
established. I will advise the briefing official of any change in my status so
as to permit his review and, where necessary, effect an appropriate debriefing,
Signature
Printed Name
-Department of State
Date
Witnessed By:.
Title Organization
/e , ~ d5 / On
SECRET
Approved For Release 2002/0611 (elA-IC&PPAO%b4R000600160001-2
 Approved For Release 2002/06/19 CIA-RDP87B01034R000600160601-2
AGREEMENT
I have read and fully understand the briefing statement made
available to me regarding Project By virtue of this briefing, I
acknowledge that I have been the recipient of information relating to a highly
classified program of interest to the United States Government.
I have been advised that due to.tbe nature of this activity and the
maximum Presidential priority placed upon secure accomplishment, extreme
security measures and controls will be extended to protect program information.
Therefore, access to the actual program and related information is strictly
limited, and approval for access is granted only when it can be demonstrated
that the individual will directly further the program and/or provide needed
support. _
In order to avoid any possible misunderstanding of the security factors
involved, everyone cleared for access to receives this briefing.
information will not be disseminated without the prior approval of Project Head-
quarters and there is to be no reference to with other than
cleared personnel.
;Having reviewed the above, I hereby-accept the responsibility to
handle information concerning in accord with the security measures
established. I will advise the briefing official of any change in my status so as
to permit his review and, where necessary, effect an appropriate de-briefing.
(Signature)
(Title)
s ia?e `
Witne
L_&'( tment of State
(Organization)
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