C I V P O L P R O G R A M I R A Q

P r o g r a m M a n a g e m e n t O f f i c e

C a m p K l e c k e r

B a g h d a d , I r a q

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CPATT/DynCorp - Camp Klecker, Unit No 43149 - APO AE 09344 3149

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Policy Receipt Acknowledgement

CIV 3201
Media Relations and Confidentiality Policy
Effective Date: 1 November 2006
Revised Date: 20 October 2007

I ___________________________________ ,

employee ID number _______________, assigned to the DI

Print Name

Clock Number

CIVPOL Iraq program as of the date below, hereby certify that:

1. I have received a copy of, and have read the CIVPOL Media Relations and Confidentiality Policy,

effective date 1 November 2006, with a revision date of 20 October 2007.

2. I understand that if I have questions, at any time, regarding the CIVPOL Media Relations and

Confidentiality policy, I will consult with my immediate Supervisor or my Human Resources staff

members.

3. I agree to comply with the CIVPOL Media Relations and Confidentiality Policy and will immediately

report through my Supervisor all instances of which I become aware the CIVPOL Media Relations

and Confidentiality Policy appears to have not been followed;

and

4. I acknowledge that any failure to fully comply with the CIVPOL Media Relations and Confidentiality

Policy may result in disciplinary action up to and including termination, without the necessity of my

receiving any prior warning or second chance.

__________________________________

_________________

Employee

Signature Date

__________________________________

Employee

Name

(Print)