Criminal Records Regulations (SOR/2000-303)

This form is to be used by a person applying for a position with a person or organization responsible for the well-being of one or more children or vulnerable persons, if the position is a position of authority or trust relative to those children or vulnerable persons and the applicant wishes to consent to a search being made in criminal conviction records to determine if the applicant has been convicted of a sexual offence listed in the schedule to the Criminal Records Act and has been pardoned.

Identification of the Applicant

• Full name:
• Sex:
• Date of birth:
• Place of birth:
• Address:
• Previous addresses (if any) within the last five years:

Reason for the Consent

I am an applicant for a paid or volunteer position with a person or organization responsible for the well-being of one or more children or vulnerable persons.

Description of the paid or volunteer position:

Name of the person or organization:

Provide details regarding the children or vulnerable persons:

Consent

I consent to a search being made in the automated criminal records retrieval system maintained by the Royal Canadian Mounted Police to find out if I have been convicted of, and have been granted or issued a pardon for, any of the sexual offences that are listed in the schedule to the Criminal Records Act.

I understand that if, as a result of giving this consent, a search discloses that there is a record of my conviction for one of the sexual offences listed in the schedule to the Criminal Records Act in respect of which a pardon was granted or issued, that record shall be provided by the Commissioner of the Royal Canadian Mounted Police to the Solicitor General of Canada, who may then disclose all or part of the information contained in that record to a police force or other authorized body. That police force or authorized body will then disclose that information to me. If I further consent in writing to disclosure of that information to the person or organization referred to above that requested the verification, that information will be disclosed to that person or organization.

This form is to be used by a person who has consented to a search being made in criminal conviction records by completing the form entitled “Consent for a Criminal Record Search for a Sexual Offence for Which a Pardon Has Been Granted or Issued” and who wishes to consent to the disclosure of information obtained in that search to the person or organization who requested the search.

Identification of Person Consenting

• Full name:
• Sex:
• Date of birth:
• Place of birth:
• Address:
• Previous addresses (if any) within the last five years:

Reason for the Consent

I am an applicant for a paid or volunteer position with a person or organization responsible for the well-being of one or more children or vulnerable persons.

Description of the paid or volunteer position:

Name of the person or organization:

Provide details regarding the children or vulnerable persons:

Consent

I consent to information contained in a criminal record, found as a result of a criminal record search for a sexual offence for which a pardon has been granted or issued, being disclosed by a police force or other authorized body to the person or organization referred to above to whom or to which I am applying or have applied for a paid or volunteer position.

I understand that as a result of giving this consent, that information will be disclosed by the police force or other authorized body to the person or organization, even though a pardon has been granted or issued for the offence.