+SZIVRQIRX+SYZIVRIQIRXSJ'EREHEHY'EREHE[LIRGSQTP - PDF document

+SZIVRQIRX+SYZIVRIQIRXSJ'EREHEHY'EREHE[LIRGSQTPIXIH  3**-')97)320=(ITEVXQIRX3VKERM^EXMSRRYQFIV*MPIRYQFIV PERSONNEL SCREENING, CONSENT AND AUTHORIZATION FORM 238)*SV4VMZEG]%GX7XEXIQIRXVIJIVXS7IGXMSR'SJXLMWJSVQERHJSVGSQTPIXMSRMRWXVYGXMSRWVIJIVXSEXXEGLIHMRWXVYGXMSRW4PIEWIX]TI[VMXISVTVMRXMRFPSGOPIXXIVW 2I[9THEXI9TKVEHI8VERWJIV7YTTPIQIRXEP6IEGXMZEXMSR8LIVItYIWXIHPIZIPSJVIPMEFMPMX]WIGYVMX]GLIGOW 6IPMEFMPMX]7XEXYW0IZIP-'32*-()28-%0 0IZIP--7)'6)8 0IZIP---8347)'6)8 3XLIV4%68-'90%673*%443-281)28%77-+21)28'3286%'8-RHIXIVQMREXI8IVQ'SRXVEGX-RHYWXV]3XLIVWTIGMJ]WIGSRHQIRXEWWMKRQIRXIXG  +SZIVRQIRX+SYZIVRIQIRXSJ'EREHEHY'EREHE4)67322)07'6))2-2+'327)28%2(%98,36->%8-32*361   'SQQIRXW '327)28%2(:)6-*-'%8-328SFIGSQTPIXIHF]XLIETTPMGERXERHEYXLSVM^IH(ITEVXQIRXEP%KIRG]3VKERM^EXMSREP3JJMGMEP        [LIRGSQTPIXIH 7YVREQIERHJYPPKMZIRREQIW(EXISJFMVXL=1('LIGOW6ItYMVIH7II-RWXVYGXMSRW %TTPMGERXWMRMXMEPW2EQISJSJJMGMEPTVMRX 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Part C - Applicant's signature and date only are required 3XLIV8LMWWLSYPHFIYWIHXSMHIRXMJ]MJXLIWIGYVMX]WGVIIRMRKMWJSV7MXI%GGIWW2%837-+-28IXG7IGXMSR&&MSKVETLMGEP-RJSVQEXMSR 8SFIGSQTPIXIHF]XLIETTPMGERX-JQSVIWTEGIMWVItYMVIHYWIEWITEVEXIWLIIXSJTETIV)EGLWLIIXQYWXFIWMKRIH'SYRXV]SJ&MVXL*SV2);VItYIWXWMJFSVREFVSEHSJ'EREHMERTEVIRXWTPIEWITVSZMHIEGST]SJ]SYV'IVXMJMGEXISJ6IKMWXVEXMSRSJ&MVXL%FVSEH-J]SYEVVMZIHMR'EREHEPIWWXLERJMZI]IEVWEKSTVSZMHIEGST]SJXLI-QQMKVEXMSR:MWE6IGSVHSJ0ERHMRKHSGYQIRXSVEGST]SJTEWWTSVX List only criminal convictions for which a pardon has NOT been granted. Include on a separate attached sheet of paper, if more than one GSRZMGXMSR%TTPMGERXQYWXMRGPYHIXLSWIGSRZMGXMSRWSYXWMHI'EREHE3JJIRGIWYRHIVXLI2EXMSREP(IJIRGI%GXEVIXSFIMRGPYHIHEW[IPPEWGSRZMGXMSRWF]GSYVXWQEVXMEPEVIXSFIVIGSVHIH7IGXMSR''SRWIRXERH:IVMJMGEXMSR A copy of Section "C" may be released to institutions to provide acknowledgement of consent. 'VMQMREPVIGSVHGLIGOWJMRKIVTVMRXWQE]FIVItYMVIH ERHGVIHMXGLIGOWEVIXSFIEVVanged through the Departmental Security Office or the delegated Officer. 'SRWIRXQE]FIKMZIRSRP]F]ERETTPMGERX[LSLEWVIEGLIHXLIEKISJQENSVMX]SXLIV[MWIXLIWMKREXYVISJETEVIRXSVKYEVHMn is mandatory. The age of majority is: 19 years in NFLD., N.S., N.B., B.C., Yukon, Norhwest Territories and Nunavut; 18 years in P.E.I., Que., Ont., Man., Sask. and Alta. The applicant will provide initials in the " applicant's initials box". 8LISJJMGMEP[LSGEVVMIHSYXXLIZIVMJMGEXMSRSJXLIMRJSVQEXMSR[MPPTVMRXXLIMVREQIMRWIVXXLIMVMRMXMEPWERHXIPITLSRIRYber in the required space. 6IPMEFMPMX]7GVIIRMRKJSVEPPX]TIWSJWGVIIRMRKMHIRXMJMIH[MXLMR7IGXMSR% GSQTPIXIRYQFIVWERHERHMJETTPMGEFP7IGYVMX]'PIEVERGIJSVEPPX]TIWSJWGVIIRMRKMHIRXMJMIH[MXLMR7IGXMSR% GSQTPIXIRYQFIVWXSERH[LIVIETTPMGEFPI3XLIVRYQFIVMWYWIHSRP][LIVITVMSV8VIEWYV]&SEVHSJ'EREHE7IGVIXEVMEXETTVSZEPLEWFIIRSFXEMRIH7IGXMSR(6IZMI[ 8SFIGSQTPIXIHF]EYXLSVM^IH(ITEVXQIRXEP%KIRG]3VKERM^EXMSREP3JJMGMEP[LSMWVIWTSRWMFPIJSVIRWYVMRKXLIGSQTPIXMSRSJWIGXMSRW%XS'EWVItYIWXIH Section E (Approval) %YXLSVM^IH(ITEVXQIRXEP%KIRG]3VKERM^EXMSREP7IGYVMX]3JJMGMEP refers to the individuals as determined by departments, agencies, and SVKERM^EXMSRWXLEXQE]ZIVMJ]VIPMEFMPMX]MRJSVQEXMSRERHSVETTVSZIRSXETTVSZIVIPMEFMPMX]WXEXYWERHSVWIGYVMX]GPIEVERGIW Approved Reliability 7XEXYWERH0IZIP---ERH---EW[IPPEWXLIWMKREXYVISJXLIEYXLSVM^IHWIGYVMX]SJJMGMEPSVQEREKIVEVIEHHIHJSV+SZIVRQIt of Canada use only. %TTPMGERXWEVIXSFIFVMIJIHEGORS[PIHKIERHFITVSZMHIH[MXLEGST]SJXLI7IGYVMX]7GVIIRMRK'IVXMJMGEXIERH&VMIJMRK*SV (TBS/SCT 330-47)". 2SXI: Private sector organizations do not have the authority to approve any level of security screening. 4LSXSKVETLW(ITEVXQIRXW%KIRGMIW3VKERM^EXMSRWEVIVIWTSRWMFPIJSVIRWYVMRKXLEXXLVIIGSPSYVTLSXSKVETLWSJTEWWTSVXWM^IEVIEXXEGLIHXSXLIJSVQJSVXLIMRZIWXMKEXMRKEKIRG]1E\MQYQHMQIRWMSRWEVIQQ\QQERHQMRMQYQEVIQQ\QQ8LIJEGIPIRKXLJVSQGLMRXSGVS[RSJLIEHQYWXFIFIX[IIRQQ\QQ8LITLSXSKVETLWQYWXFIWMKRIHF]XLIETTPMGERXERHEREYXLSVM^IHWIGYVMX]SJJMGMEP8LITLSXSKVETLWQYWXLEZIFIIRXEOIR[MXLMRXLIPEWXWM\QSRXLW-XMWVItYMVIHJSVRI[SVYTKVEHI0IZIP---WIGYVMX]GPIEVERGIWJSVMHIRXMJMGEXMSRSJXLIETTPMGERXHYVMRKXLIWIGYVMX]WGVIIRMRKMRZIWXMKEXMSRF]XLIMRZIWXMKEXMRKEKIRG]8LIMRZIWXMKEXMRKEKIRG]QE]MRWTIGMJMGMRGMHIRXWVItYIWXETLSXSKVETLJSVE0IZIP-SV--GPIEVERGIW[LIRERMRZIWXMKEXMSRMWVItYMVIH8&77'8)6IZ  +SZIVRQIRX+SYZIVRIQIRXSJ'EREHEHY'EREHE-27869'8-327*364)67322)07'6))2-2+'327)28%2(%98,36->%8-32*3618&77'8)6IZ 3RGIGSQTPIXIHXLMWJSVQWLEPPFIWEJIKYEVHIHERHLERHPIHEXXLIPIZIPSJ4VSXIGXIH%+IRIVEP-JWTEGIEPPSXXIHMRER]TSVXMSRMWMRWYJJMGMIRXTPIEWIYWIWITEVEXIWLIIXYWMRKWEQIJSVQEX7IGXMSR%%HQMRMWXVEXMZI-RJSVQEXMSR %YXLSVM^IH(ITEVXQIRXEP%KIRG]3VKERM^EXMSREP3JJMGMEP8LI3JJMGMEPFEWIHSRMRWXVYGXMSRWMWWYIHF]XLI(ITEVXQIRXEP7IGYVMX]3JJMGIVQE]FIVIWTSRWMFPIJSVHIXIVQMRMRKFEWIHSRJMZI]IEVFEGOKVSYRHLMWXSV][LEXGSRWXMXYXIWWYJJMGMIRXZIVMJMGEXMSRSJTIVWSREPHEXEIHYGEXMSREPERHTVSJIWWMSREPtYEPMJMGEXMSRWERHIQTPS]QIRXLMWXSV]6IJIVIRGIWEVIXSFIPMQMXIHXSXLSWITVSZMHIHSRXLIETTPMGEXMSRJSVIQTPS]QIRXSVItYMZEPIRXJSVQW79440)1)28%0-2*361%8-326)59-6)1)2874IVWSRW[LSTVIWIRXP]LSPHE7)'96-8='0)%6%2')ERHWYFWItYIRXP]QEVV]VIQEVV]SVGSQQIRGIEGSQQSRPE[TEVXRIVWLMTMREHHMXMSRXSLEZMRKXSYTHEXIWIGXMSRWSJXLI7IGYVMX]'PIEVERGI*SVQ8&77'8 EVIVItYMVIHXSWYFQMXERSVMKMREP4IVWSRRIP7GVIIRMRK'SRWIRXERH%YXLSVM^EXMSR*SVQ[MXLXLIJSPPS[MRKTEVXWGSQTPIXIHPart A - As set forth in each question Part B - As set forth in each question, excluding CRIMINAL CONVICTIONS IN AND OUTSIDE OF CANADA. Part C - Applicant's signature and date only are required 3XLIV8LMWWLSYPHFIYWIHXSMHIRXMJ]MJXLIWIGYVMX]WGVIIRMRKMWJSV7MXI%GGIWW2%837-+-28IXG7IGXMSR&&MSKVETLMGEP-RJSVQEXMSR 8SFIGSQTPIXIHF]XLIETTPMGERX-JQSVIWTEGIMWVItYMVIHYWIEWITEVEXIWLIIXSJTETIV)EGLWLIIXQYWXFIWMKRIH'SYRXV]SJ&MVXL*SV2);VItYIWXWMJFSVREFVSEHSJ'EREHMERTEVIRXWTPIEWITVSZMHIEGST]SJ]SYV'IVXMJMGEXISJ6IKMWXVEXMSRSJ&MVXL%FVSEH-J]SYEVVMZIHMR'EREHEPIWWXLERJMZI]IEVWEKSTVSZMHIEGST]SJXLI-QQMKVEXMSR:MWE6IGSVHSJ0ERHMRKHSGYQIRXSVEGST]SJTEWWTSVX List only criminal convictions for which a pardon has NOT been granted. Include on a separate attached sheet of paper, if more than one GSRZMGXMSR%TTPMGERXQYWXMRGPYHIXLSWIGSRZMGXMSRWSYXWMHI'EREHE3JJIRGIWYRHIVXLI2EXMSREP(IJIRGI%GXEVIXSFIMRGPYHIHEW[IPPEWGSRZMGXMSRWF]GSYVXWQEVXMEPEVIXSFIVIGSVHIH7IGXMSR''SRWIRXERH:IVMJMGEXMSR A copy of Section "C" may be released to institutions to provide acknowledgement of consent. 'VMQMREPVIGSVHGLIGOWJMRKIVTVMRXWQE]FIVItYMVIH ERHGVIHMXGLIGOWEVIXSFIEVVanged through the Departmental Security Office or the delegated Officer. 'SRWIRXQE]FIKMZIRSRP]F]ERETTPMGERX[LSLEWVIEGLIHXLIEKISJQENSVMX]SXLIV[MWIXLIWMKREXYVISJETEVIRXSVKYEVHMn is mandatory. The age of majority is: 19 years in NFLD., N.S., N.B., B.C., Yukon, Norhwest Territories and Nunavut; 18 years in P.E.I., Que., Ont., Man., Sask. and Alta. The applicant will provide initials in the " applicant's initials box". 8LISJJMGMEP[LSGEVVMIHSYXXLIZIVMJMGEXMSRSJXLIMRJSVQEXMSR[MPPTVMRXXLIMVREQIMRWIVXXLIMVMRMXMEPWERHXIPITLSRIRYber in the required space. 6IPMEFMPMX]7GVIIRMRKJSVEPPX]TIWSJWGVIIRMRKMHIRXMJMIH[MXLMR7IGXMSR% GSQTPIXIRYQFIVWERHERHMJETTPMGEFP7IGYVMX]'PIEVERGIJSVEPPX]TIWSJWGVIIRMRKMHIRXMJMIH[MXLMR7IGXMSR% GSQTPIXIRYQFIVWXSERH[LIVIETTPMGEFPI3XLIVRYQFIVMWYWIHSRP][LIVITVMSV8VIEWYV]&SEVHSJ'EREHE7IGVIXEVMEXETTVSZEPLEWFIIRSFXEMRIH7IGXMSR(6IZMI[ 8SFIGSQTPIXIHF]EYXLSVM^IH(ITEVXQIRXEP%KIRG]3VKERM^EXMSREP3JJMGMEP[LSMWVIWTSRWMFPIJSVIRWYVMRKXLIGSQTPIXMSRSJWIGXMSRW%XS'EWVItYIWXIH Section E (Approval) %YXLSVM^IH(ITEVXQIRXEP%KIRG]3VKERM^EXMSREP7IGYVMX]3JJMGMEP refers to the individuals as determined by departments, agencies, and SVKERM^EXMSRWXLEXQE]ZIVMJ]VIPMEFMPMX]MRJSVQEXMSRERHSVETTVSZIRSXETTVSZIVIPMEFMPMX]WXEXYWERHSVWIGYVMX]GPIEVERGIW Approved Reliability 7XEXYWERH0IZIP---ERH---EW[IPPEWXLIWMKREXYVISJXLIEYXLSVM^IHWIGYVMX]SJJMGMEPSVQEREKIVEVIEHHIHJSV+SZIVRQIt of Canada use only. %TTPMGERXWEVIXSFIFVMIJIHEGORS[PIHKIERHFITVSZMHIH[MXLEGST]SJXLI7IGYVMX]7GVIIRMRK'IVXMJMGEXIERH&VMIJMRK*SV (TBS/SCT 330-47)". 2SXI: Private sector organizations do not have the authority to approve any level of security screening. 4LSXSKVETLW(ITEVXQIRXW%KIRGMIW3VKERM^EXMSRWEVIVIWTSRWMFPIJSVIRWYVMRKXLEXXLVIIGSPSYVTLSXSKVETLWSJTEWWTSVXWM^IEVIEXXEGLIHXSXLIJSVQJSVXLIMRZIWXMKEXMRKEKIRG]1E\MQYQHMQIRWMSRWEVIQQ\QQERHQMRMQYQEVIQQ\QQ8LIJEGIPIRKXLJVSQGLMRXSGVS[RSJLIEHQYWXFIFIX[IIRQQ\QQ8LITLSXSKVETLWQYWXFIWMKRIHF]XLIETTPMGERXERHEREYXLSVM^IHWIGYVMX]SJJMGMEP8LITLSXSKVETLWQYWXLEZIFIIRXEOIR[MXLMRXLIPEWXWM\QSRXLW-XMWVItYMVIHJSVRI[SVYTKVEHI0IZIP---WIGYVMX]GPIEVERGIWJSVMHIRXMJMGEXMSRSJXLIETTPMGERXHYVMRKXLIWIGYVMX]WGVIIRMRKMRZIWXMKEXMSRF]XLIMRZIWXMKEXMRKEKIRG]8LIMRZIWXMKEXMRKEKIRG]QE]MRWTIGMJMGMRGMHIRXWVItYIWXETLSXSKVETLJSVE0IZIP-SV--GPIEVERGIW[LIRERMRZIWXMKEXMSRMWVItYMVIH8&77'8)6IZ