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    Police Record Check Form (Peel Police) - Youth (14-17)

    Uploaded by

    Jay Patel
    The document is a consent form for a criminal record check from Peel Regional Police. It requests information such as name, address, date of birth, and identification documents. The applicant consents to the police searching criminal databases to obtain their criminal record and disclose it to them. For a vulnerable sector check, the applicant also consents to a search of the sexual offense record suspensions database. The check can be for employment, volunteering, or other purposes. Three levels of checks are available with different records disclosed for each.

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    Download as PDF, TXT or read online from Scribd

    Police Record Check Form (Peel Police) - Youth (14-17)

    Uploaded by

    Jay Patel
    116 views1 page
    The document is a consent form for a criminal record check from Peel Regional Police. It requests information such as name, address, date of birth, and identification documents. The applicant consents to the police searching criminal databases to obtain their criminal record and disclose it to them. For a vulnerable sector check, the applicant also consents to a search of the sexual offense record suspensions database. The check can be for employment, volunteering, or other purposes. Three levels of checks are available with different records disclosed for each.

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    The document is a consent form for a criminal record check from Peel Regional Police. It requests information such as name, address, date of birth, and identification documents. The applicant consents to the police searching criminal databases to obtain their criminal record and disclose it to them. For a vulnerable sector check, the applicant also consents to a search of the sexual offense record suspensions database. The check can be for employment, volunteering, or other purposes. Three levels of checks are available with different records disclosed for each.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    116 views1 page

    Police Record Check Form (Peel Police) - Youth (14-17)

    Uploaded by

    Jay Patel
    The document is a consent form for a criminal record check from Peel Regional Police. It requests information such as name, address, date of birth, and identification documents. The applicant consents to the police searching criminal databases to obtain their criminal record and disclose it to them. For a vulnerable sector check, the applicant also consents to a search of the sexual offense record suspensions database. The check can be for employment, volunteering, or other purposes. Three levels of checks are available with different records disclosed for each.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Peel Regional Police

    Consent to Conduct Police Records Check


    **Must live in Mississauga or Brampton and have proof of address**
    Must Select One: Criminal Record Check – Level One
    ✔ Criminal Record and Judicial Matters Check – Level Two

    Vulnerable Sector Check – Level Three

    TO BE COMPLETED BY APPLICANT Adult Youth Date of Request (YYYY-MM-DD)


    Current Address (name, street, city, province, postal code) ✔
    **Print UNDER each heading**
    Last Name First Name Middle Name

    # and Street Name Apt/Unit # Maiden Name or Other Last Names Other First Names

    City Province Postal Code Date of Birth (YYYY-MM-DD) Country of Birth Gender

    Contact Phone Number(s) Email Address

    Address History – Complete address history for the past 5 years.


    Street Name and # (please state below) Apt/Unit # City Province # of Years
    Same as above ----- ----- -----

    Identification – Two pieces of valid government issued identification required. One must have date of birth and photo.
    Type of Identification produced Type of Identification produced

    Reason for Request - (please fill out the following)


    ✔ Volunteer Employment School Requirement Licensing Other – Please specify:
    Fill out the below ONLY if request is Vulnerable Sector Check
    Name of Employer/Organization/School/Other requesting Vulnerable Sector Check Job Title/Position/Program Name
    CITY OF BRAMPTON, COMMUNITY SERVICES, RECREATION Volunteer - Recreation Division
    Check box of Vulnerable Person(s) you will be responsible for the well-being of (can check off more than one (1) if applicable):
    ✔ Children ✔ Elderly (over 65) ✔ Other – please specify: Persons with disabilities

    Youths requiring a records check for a position with a government agency must provide the following:
    Name of Government Agency
    City of Brampton
    Address of Government Agency
    8 Nelson Street West, Brampton, ON, L6X 1B7
    Position with Government Agency Contact at Government Agency Phone Number
    Programmer, Community Development MERIN KURIAKOSE 9058745576
    The Criminal Record Check will include the following information as it exists on the date of the search:
     Criminal convictions from the Canadian Police Information Centre “CPIC” and/or local databases and Summary convictions for the past five
    (5) years, when identified
    The Criminal Record and Judicial Matters Check will include all of the above and the following information as it exists on the date of the
    search:
     Outstanding entries such as charges and warrants, judicial orders, Probation and Prohibition Orders – as per CPIC policy, information
    obtained from the Investigative Databank must be confirmed and authorized for release by the contributing agency
     Absolute and Conditional Discharges per the Police Record Checks Reform Act schedule
    The Vulnerable Sector Check will include all of the above and the following information as it exists on the date of the search:
     In very exceptional cases, where it meets the Public Safety Test, non-conviction dispositions including but not limited to, Withdrawn and
    Dismissed
     Not Criminally Responsible by Reason of Mental Disorder
     All record suspensions for release by the Minister of Public Safety
    CONSENT
    1. I hereby authorize the Peel Regional Police to conduct a search based on the names(s), date of birth and declared criminal record history,
    to obtain the information required to complete the Police Record Check and disclose such information to me. This includes a search of the
    Peel Regional Police Records Management Systems (RMS), and the Canadian Police Information Centre (CPIC) database, maintained by
    the RCMP. This search of the CPIC database includes a search of the Identification Data Bank (known as the National Respository of
    Criminal Records), the Investigative Data Bank and the Police Information Portal (PIP).
    2. I hereby release and discharge the Peel Regional Police Services Board and all members and employees of the Peel Regional Police
    from any and all actions, claims and demands for damages, loss or injury howsoever arising which may hereafter be sustained by myself as
    a result of the disclosure of the information to me by the Peel Regional Police. I hereby authorize the Peel Regional Police to inquire into
    and disclose results of any police records to me including: criminal convictions (summary and indictable); absolute and conditional
    discharges; and cases of not criminally responsible for reasons of mental disorder; outstanding entries such as charges, judicial orders,
    probation and prohibition orders and to conduct a local police contact search with any Police Service in Canada.
    3. I certify that the information provided by me in this application is true and correct to the best of my knowledge and belief. I have read this
    consent, understand it, and agree to it in its entirety.
    4. For Vulnerable Sector Check applicants that are 18 years of age or older: I hereby 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 been
    granted a record suspension (pardon) for, any sexual offences that are listed in the schedule to the Criminal Records Act. I understand that,
    as a result of giving this consent, if I am suspected of being the person named in a criminal record for one of the sexual offences listed in
    the schedule to the Criminal Records Act in respect of which a record suspension was granted or issued, I will be requested to provide
    fingerprints to confirm that record and that record may be provided by the Commissioner of the Royal Canadian Mounted Police to the
    Minister of Public Safety, 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 the above that requested the verification, that information will be disclosed to that
    person or organization.
    5. I understand that the prescribed fee is non-refundable.

    Applicant’s Signature: Date (YYYY-MM-DD):

    PRP657
    Nov/18

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