(Contractor Name) CJIS
Security Awareness
Training Certification Form
Criminal Justice Information Services (CJIS) Security Policy
I acknowledge that I have viewed the Security Awareness course material provided by
(Contractor Office) or have attended Security Awareness Training provided by my employer. I
further acknowledge that I am responsible for familiarizing myself with the documents contained
on the Security Awareness training and that I can be held civilly and/or criminally
accountable for failing to comply with the rules and requirements set forth therein. As per
CJIS Regulations this training must be attended every two years. Consider all fields on
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this form MANDATORY.
Please Complete on the Computer or Print Legibly:
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First Name: ____________________________ Last Name: ________________________________
am
Date of Birth ____________________ Identification Number ________________________State: ____
Email: ____________________________________________________________________________
Company or Personal Email
Ex
Classroom Training Provided by: ________________________________________________________
Company and Phone Number
Date of Training: _____________________ Contractor Classroom Training
(Check Type of Training)
By signing this form I acknowledge that I have viewed the Security Awareness Presentation through
(Contractor Office) or received Security Awareness Training through a Company Training program and
understand the rules, regulations and security associated with working on computers, computer
networks, or in facilities that may provide access to criminal justice information.
Signature: _______________________________________ Date: ___________________________