Non-Employee Consent for Network Access

This form must be completed by the person requiring access (NOT a county employee). Your contact information will only be used for county business.

Name

Agency/Affiliation

Email

Phone Number

Enter last 4 digits of your Social Security Number to be used as your Authentication Number

Recaptcha Response
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Acknowledgement

By checking this box, I agree that the County of Chester’s (County) computer systems, databases, and network are private computing systems (information systems) for use only by authorized users. Unless I have been granted permission to the County system, any access by me to the County system for which permission has not been granted may expose me to criminal and/or civil proceedings. My use of this system, and all information or communications accessed, stored, or transmitted on it by me, with or without authority, or in excess of my authority, is subject to review, monitoring, and recording by County system personnel, without notice or permission. Any information or data thus obtained by County system personnel also are subject to review by law enforcement and judicial officials in connection with the investigation or prosecution of possible criminal activity involving the system.

disregard this