Criminal Record Verification Informed Consent Form Canada, Surname (last name) ______________________ Given A Declaration of Criminal Record does not constitute a Certified Criminal Record by the RCMP and may not contain all criminal record convictions. I certify that the information set out by me in this application is true and correct to the best of my ability. Instructions for completing the Criminal Record Verification Informed Consent Form For your convenience we have included a guide for completing this form attached after the form. CRIMINAL RECORD VERIFICATION Informed Consent Form Name and location of the company where information will be stored in Canada: Mintz Global Screening Inc. Informed Consent SEARCH AUTHORIZATION – I HEREBY CONSENT TO THE SEARCH OF the RCMP National Repository of Criminal Records based on the name(s), date of birth and Informed Consent Form Name and location of the company where information will be stored in Canada: CSI Background Screening, Halifax, Nova Scotia, Canada **Information related to this Declaration of Criminal Record This form is required to be filled and attached to your Informed Consent Form for a Criminal Record Check (CRC). Declaration of Criminal Record This form is required to be filled and attached to your Informed Consent Form for a Criminal Record Verification. BACKGROUND CHECK CONSENT FORM The Privy Council Office is committed to protecting the personal information it collects to assess suitability for appointment to a public office position. Declaration of Criminal Record This form is required to be filled and attached to your Informed Consent Form for a Criminal Record Check (CRC). **Information related to this criminal record check is collected, retained and disclosed in accordance with applicable privacy legislation. Section B – Reason for the Criminal Record Verification or employment, school or volunteer purposes.
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