Employee File: ________________(name)
XX Agency
CERTIFICATION OF INFORMATION SECURITY AWARENESS
TRAINING FORM
This is to certify that _____________________ of XX Agency has received “General
User Level” Security Awareness Training” based on the standards set forth in NIST Special
Publication #SP-800-16. The training is mandatory—it fulfills the requirement set forth in OMB
Circular A-130, Appendix III. The individual named above received this training on
_______________, 2000.
This is to certify that _____________________ of XX Agency has received “Advanced
Level Security Awareness Training” based on the standards set forth in NIST Special
Publication #SP-800-16. The Advanced Level is specifically designed for Systems
Administrators, Database Administrators, Network Architects & Engineers, and Information
System Security Professionals. This training is mandatory—it fulfills the requirement set forth
in OMB Circular A-130, Appendix III. The individual named above received this training on
_________________, 2000.
This is to certify that _____________________ of XX Agency has received “Executive
Level Security Awareness Training” based on the standards set forth in NIST Special
Publication #SP-800-16. The Executive Level is specifically designed for Team Leaders, Branch
Chiefs, Division Chiefs, and others involved in making decisions regarding Information Systems
Security in the Lifecycle. This training is mandatory; it fulfills the requirement set forth in OMB
Circular A-130, Appendix III. The individual named above received this training on
_________________, 2000.
_______________________/_______
Employee Signature/Date
_____________________/_______
Trainer Signature/Date
NOTE: This information will become part of the official XX Agency Training Records for
tracking purposes only.