Acknowledgment of Obligations
1.	I acknowledge that during my employment with ___________ I have received or been exposed to trade secrets of the Company including, but not limited to, the following: [check applicable boxes]
[   ] Financial data
[   ] Price or costing data
[   ] Customer and vendor lists
[   ] Marketing plans and data
[   ] Personnel data
[   ] Technical information concerning Company research and development projects, including [describe] ________________
[   ] Product design and specification data, including [describe] _______________
[   ] Patent applications and disclosures, including [describe] ______________
[   ] Product information, including [describe] ______________
[   ] Other [describe] ______________
2.	I have read, signed and been furnished with a copy of my [choose one] Employment/Nondisclosure Agreement with the Company. I have complied with and will continue to comply with all of the provisions of the Agreement, including my obligation to preserve as confidential all of the Company's trade secrets.
3.	I do not have in my possession original documents, copies of them or any other thing containing Company trade secrets. I have not disclosed Company trade secrets to anyone not authorized by the Company to receive them.
4.	I have returned to my supervisor all identification badges, keys and other access devices issued to me by the Company.

_________________________________________________________
(Signature)
___________________________
(Typed or Printed Name)
Date: _____________