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EDEX Client Acknowledgment Of Legal Constraints On Access To Information And Use Of Information - California
| EDEX Client Acknowledgment Of Legal Constraints On Access To Information And Use Of Information Form. This is a California form and can be used in General Workers Comp . |
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California Department of Industrial Relations Division of Workers' Compensation EDEX CLIENT ACKNOWLEDGMENT OF LEGAL CONSTRAINTS ON ACCESS TO INFORMATION AND USE OF INFORMATION A. Information for EDEX Clients. The DWC Electronic Data Exchange (EDEX) allows access to certain WCAB records via electronic transmissions performed by a Subscriber. The Subscriber's transmissions requesting electronic data from the WCAB are considered requests pursuant to the California Public Records Act (Government Code ยง6250 et seq.) for access to public records of the WCAB. The Public Records Act encourages public access to information in the possession of public agencies. However, Government Code Section 6255 authorizes denial of access to public records if the public agency determines by the facts of a particular case that the ultimate use of the information does not serve a legitimate purpose. Since Subscriber will be seeking electronic access to public records available through EDEX on your behalf, you must certify by signing this Acknowledgment that you will not seek or use EDEX information contrary to state or federal law, and that you will abide by the conditions of access to information set forth in this agreement. The Client should be aware that the fact that a Client has submitted an EDEX inquiry and/or received EDEX information is, in itself, a matter of public record. The Division reserves to itself the right to notify any individual about whom an EDEX inquiry is made of the nature and source of that inquiry, including the identity of the Client that submitted the inquiry, and to provide the individual with a copy of the request and any information provided in response thereto. B. Identifying Information. Subscriber Name: ______________________ Subscriber Account #: ____________________ Client Identification Number: Client Name: ___________________________________ [DWC Use Only] _____________________________________________________________________________ Client Address: _____________________________________________________________________________ Contact Person: _____________________________________________________________________________ Phone Number: _____________________________________________________________________________ Owner(s), Partners(s), Corporate Officers/Title(s): _______________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ EDEX Client Acknowledgment Rev. 6/2006 1 American LegalNet, Inc. www.USCourtForms.com Licenses: If Client is licensed by the State of California, or if Client holds a license issued under the Business and Professions Code (such as a license issued by the Medical Board, or the State Board of Chiropractic Examiners), or the State Bar of California, provide the name of the agency issuing the license, type of license, license number and date license expires. ____________________________________________________________________________ What type of business is client engaged in? ____________________________________________________________________________ Client represents that it will be seeking information through EDEX for the following purposes: ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ C. Disclaimer Of Warranty. Client hereby acknowledges that the use of the EDEX system and the information contained therein is at the Client's sole risk. The information provided from the EDEX system is provided "as is" and without warranty of any kind. The Division believes that the information contained in the EDEX system is accurate, and will use its best efforts to correct any errors in this information that are brought to its attention. The Division does not warrant that the function of the EDEX system will meet your data requirements or that the operation of the system will be uninterrupted or error free. The Division expressly disclaims any and all warranties, express or implied, including, but not limited to, the implied warranties of merchantability and fitness for a particular purpose. D. Conditions Of Client Access To Records Obtained By Subscriber Through EDEX. Civil Code section 1798.81.5 (b) provides that "A business that owns or licenses personal information about a California resident shall implement and maintain reasonable security procedures and practices appropriate to the nature of the information, to protect the personal information from unauthorized access, destruction, use, modification, or disclosure." A violation of Civil Code section 1798.81.5 (b) may lead to civil liability for damages and/or imposition of a civil penalty. These provisions apply to any business that maintains, transfers or stores personal information subject to section 1798.81.5 (b). In addition, Labor Code section 138.7(d) provides that: "It shall be unlawful for any person who has received individually identifiable information from the division pursuant to this section to provide that information to any person who is not entitled to it under this section." Client agrees to seek and use information obtained through EDEX for lawful purposes only, and EDEX Client Acknowledgment Rev. 6/2006 2 American LegalNet, Inc. www.USCourtForms.com agrees not to sell or otherwise make the information available to anyone other than the client whose client identification number was used in the transmission soliciting the information. With respect to use of the information, Client agrees that it shall not violate any provisions of the federal Americans With Disabilities Act, the federal Equal Employment Opportunity Act, the Federal Fair Credit Reporting Act, the California Fair Employment and Housing Act, or any privacy or confidentiality laws, now in existence or hereafter adopted. Client agrees that, if Client receives information for employment screening purposes, Client shall use the information for lawful purposes only, specifically complying with the federal Americans with Disabilities Act, the federal Equal Employment Opportunity Act, the federal Fair Credit Reporting Act, the California Fair Employment and Housing Act, or any privacy or confidentiality laws, now in effect or hereafter adopted. C
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