DJJ Form MIS1205.60 "Provider Access User Agreement" - Florida

What Is DJJ Form MIS1205.60?

This is a legal form that was released by the Florida Department of Juvenile Justice - a government authority operating within Florida. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on September 30, 2015;
  • The latest edition provided by the Florida Department of Juvenile Justice;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of DJJ Form MIS1205.60 by clicking the link below or browse more documents and templates provided by the Florida Department of Juvenile Justice.

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Download DJJ Form MIS1205.60 "Provider Access User Agreement" - Florida

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MIS 1205.60
New 9/17/99
Department of Juvenile Justice
Revised 09/30/15
PROVIDER ACCESS USER AGREEMENT
PLEASE PRINT:
USER’S LAST NAME
USER’S FIRST NAME
MI
The Department of Juvenile Justice (“the Department”) provides Juvenile Justice Information System (JJIS) Access to its
juvenile services providers and authorized agents of the Department. The individual identified below agrees that the following
terms and conditions apply to all information contained within JJIS:
1.
I understand that the purpose of my access to the Department’s JJIS is to perform business functions of the Department,
and that my access may be monitored or audited by the Department by various means, including monitoring or auditing that
may occur without my knowledge or prior notice.
2.
I will not use the Department’s JJIS network for any personal purposes, including entertainment, personal business or
personal gain.
3.
I will follow all guidelines outlined in the Access to JJIS and JJIS Data Policy, FDJJ-1205.60 and the User Password
Policy, FDJJ-1225. I am responsible for safeguarding my access to JJIS, which includes, but is not limited to the
following:
Passwords are to be treated as sensitive, shall be kept confidential, and are not to be shared with anyone including
administrative assistants, information technology professionals or supervisors. A supervisor or co-worker may not, for
any reason, ask anyone to divulge his or her password. If another person knows a user’s password, it is the user’s
responsibility to change it immediately.
Passwords should never be written down or stored online.
4.
I understand that I cannot transmit or distribute any confidential information, or violate any Federal law or the provisions
sections 984.06 and 985.04, F.S. I will not violate Department policy without the written approval of the Department.
5.
I am responsible for safeguarding my access to the Department’s JJIS Network; and that I will not provide my access
capabilities to anyone for any reason, unless authorized by Department policy or otherwise authorized in writing by the
Department.
ACKNOWLEDGEMENT (Please PRINT Clearly):
(For specific JJIS access and permission, please submit the JJIS ACCESS / PERMISSION REQUEST form.)
THE FOLLOWING FIELDS MUST BE COMPLETED BEFORE ACCESS IS GRANTED
I,
on behalf of
User’s Name
Business Name of Provider or Organizations
Work Hrs AM/PM
located at
(
)
Area Code & Work Phone Number
Mailing Address, include City, State & Zip Code
Manager/Supervisor’s Name & Phone Number
DIO Name/Circuit Number
SECURITY: Mother’s Maiden Name or D.O.B.
acknowledge that I have read, understand and agree to the terms and conditions of the Network Access User Agreement outlined
above. In addition, I further attest by my signature below, that I am authorized to enter into this agreement on behalf of the above
named Provider/Organization.
USER’S WORK E-MAIL ADDRESS
USER’S SIGNATURE (use blue or black ink)
DATE
PROVIDER/ORGANIZATION SUPERVISOR or DESIGNEE SIGNATURE (use blue or black ink)
DATE
DJJ CONTRACT MANAGER or DESIGNEE SIGNATURE
DATE
For DJJ Contract Manager Only:
User requesting access was background screened on ____________________________ by _____________________________
Date
Last Name of BSU Staff
FOR DJJ MIS STAFF ONLY:
User Name:
Created By:
Date Created:
MIS 1205.60
New 9/17/99
Department of Juvenile Justice
Revised 09/30/15
PROVIDER ACCESS USER AGREEMENT
PLEASE PRINT:
USER’S LAST NAME
USER’S FIRST NAME
MI
The Department of Juvenile Justice (“the Department”) provides Juvenile Justice Information System (JJIS) Access to its
juvenile services providers and authorized agents of the Department. The individual identified below agrees that the following
terms and conditions apply to all information contained within JJIS:
1.
I understand that the purpose of my access to the Department’s JJIS is to perform business functions of the Department,
and that my access may be monitored or audited by the Department by various means, including monitoring or auditing that
may occur without my knowledge or prior notice.
2.
I will not use the Department’s JJIS network for any personal purposes, including entertainment, personal business or
personal gain.
3.
I will follow all guidelines outlined in the Access to JJIS and JJIS Data Policy, FDJJ-1205.60 and the User Password
Policy, FDJJ-1225. I am responsible for safeguarding my access to JJIS, which includes, but is not limited to the
following:
Passwords are to be treated as sensitive, shall be kept confidential, and are not to be shared with anyone including
administrative assistants, information technology professionals or supervisors. A supervisor or co-worker may not, for
any reason, ask anyone to divulge his or her password. If another person knows a user’s password, it is the user’s
responsibility to change it immediately.
Passwords should never be written down or stored online.
4.
I understand that I cannot transmit or distribute any confidential information, or violate any Federal law or the provisions
sections 984.06 and 985.04, F.S. I will not violate Department policy without the written approval of the Department.
5.
I am responsible for safeguarding my access to the Department’s JJIS Network; and that I will not provide my access
capabilities to anyone for any reason, unless authorized by Department policy or otherwise authorized in writing by the
Department.
ACKNOWLEDGEMENT (Please PRINT Clearly):
(For specific JJIS access and permission, please submit the JJIS ACCESS / PERMISSION REQUEST form.)
THE FOLLOWING FIELDS MUST BE COMPLETED BEFORE ACCESS IS GRANTED
I,
on behalf of
User’s Name
Business Name of Provider or Organizations
Work Hrs AM/PM
located at
(
)
Area Code & Work Phone Number
Mailing Address, include City, State & Zip Code
Manager/Supervisor’s Name & Phone Number
DIO Name/Circuit Number
SECURITY: Mother’s Maiden Name or D.O.B.
acknowledge that I have read, understand and agree to the terms and conditions of the Network Access User Agreement outlined
above. In addition, I further attest by my signature below, that I am authorized to enter into this agreement on behalf of the above
named Provider/Organization.
USER’S WORK E-MAIL ADDRESS
USER’S SIGNATURE (use blue or black ink)
DATE
PROVIDER/ORGANIZATION SUPERVISOR or DESIGNEE SIGNATURE (use blue or black ink)
DATE
DJJ CONTRACT MANAGER or DESIGNEE SIGNATURE
DATE
For DJJ Contract Manager Only:
User requesting access was background screened on ____________________________ by _____________________________
Date
Last Name of BSU Staff
FOR DJJ MIS STAFF ONLY:
User Name:
Created By:
Date Created: