Evan R. Stanley, ACS Chief, on behalf of the U.S. Embassy in Sofia wishes to express the appreciation of the U.S. government and U.S. citizens in Bulgaria to __________________________ for volunteering to be a Citizen Liaison Volunteer (CLV) in Sofia’s American Liaison Network (ALN).

 

I,__________________________, hereby acknowledge that I understand and agree to the terms set forth below pertaining to information shared by me and provided to me by the U.S. government in my capacity as a CLV.

In particular, I understand:

1. Prior to my being accepted as a CLV, the Department of State will conduct an electronic records check on me in Consular records systems on the basis of the personal information I have previously provided when applying for a U.S. passport.
2. That some of the information that I will receive from the U.S. Department of State (“Department”) in my role as a CLV is subject to the Privacy Act of 1974, as amended (“Privacy Act”), when it is maintained by the Department, and that I must be exceptionally mindful of personal privacy considerations in my handling and use of such information.
3. That access to information provided to me must be limited to CLVs and authorized alternates, and storage and control of such information must be adequate to prevent access by unauthorized persons.
4. That no dissemination of, use of, or access to, the information provided to me by the U.S. Embassy Sofia shall be permitted except in accordance with the purpose for which it is provided, to wit, performing my duties as a CLV. Further, the information provided to me shall be returned to the Embassy Sofia upon completion of my tenure as a CLV.
5. That my contact information may be shared with relevant governmental and private authorities and individuals for purposes of responding to emergency situations.
6. f) That I should ask questions to my contact(s) at the consulate whenever I am unsure of my responsibilities with respect to upholding personal privacy or any other aspect of my CLV duties.

 

I, ________________________, further hereby state that I understand and agree that I am being provided an opportunity to perform the services described in the accompanying Description of Citizen Liaison Volunteer Duties on a gratuitous basis for Embassy Sofia.

I agree not to identify myself as a representative of the U.S. Government.

I understand that I will not receive any compensation in return for the services that I perform. I further agree that I waive any and all claims against the U.S. Department of State and/or the U.S. government for payment of compensation as a consequence of my performance of services under this agreement.

I agree to hold the U.S. government harmless for any liability for damages arising out of my duties as a CLV.

(Signature)
Name
Citizen Liaison Volunteer
Date

(Signature)
Name
Consular Officer
Date