Test Security Agreement

Individual Statement of Responsibility

This form is to be signed by all employees whose job in any way can impact test security.

I have read and understand the Security Agreement that begins on page one of this form

I understand that I have responsibility regarding test security and I am clear what my responsibility entails.

I certify to the truth of the above statements.

Representative: _________________________________________________________________

Signature: __________________________________________ Date _______________________

Supervisor: ____________________________________________________________________

Signature: __________________________________________ Date _______________________