TAG – Criminal Record Verification

CRIMINAL RECORD VERIFICATION

Informed Consent Form

APEX Pre-Employment Screening Services

A. Personal Information

Surname (last name) (Required)

Surname (last name) at birth (if applicable): (Required)

Given Name(s) (Required)

Former Name(s)

Place of Birth (City, Province/State, Country): (Required)

Date of Birth (YYYY-MM-DD) (Required)

Gender (check one)

Female
Male

Phone number(s): (Required)

Email address: (Required)

Current Home Address: (Required)

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

How long have you lived at this address

I have lived here for for 5 years or more
I have lived here for for less than 5 years

Previous Address within the last 5 years (Required)

Address Line 1

City

State / Province / Region

Zip / Postal Code

Country

B. Reason for Criminal Record Verification

Reason for request (Example: Employment - Employer - Job Title)

Organization requesting search: TAG Corp.

Contact Name: Darran Chambers - 1.780.668.5233

Contact Phone Number: 1.780.668.5233

C. 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 where used, the declared criminal record history provided by myself.

I understand that this verification of the National Repository of Criminal Records is not being confirmed by fingerprint comparison which is the only true means by which to confirm if a criminal record exists in the National Repository of Criminal Records.

POLICE INFORMATION SYSTEM(S) – I HEREBY CONSENT TO THE SEARCH OF police information systems, as part of a Police Information Check, which will consist of a search of the following systems:

(check applicable): (Required)

A) CPIC Investigative Data Bank

B) Police Information Portal
C) Other:

AUTHORIZATION AND WAIVER to provide a confirmation of criminal record or any police information

I certify that the information set out by me in this application is true and correct to the best of my ability.

I consent to the release of the results of the criminal record checks to Apex Pre-Employment Screening Services located in Hamilton, ON Canada.

I hereby release and forever discharge all members and employees of the processing Police Service and the Royal Canadian Mounted 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 information by the Port Hope Police Services to Apex Pre-Employment Screening Services in Hamilton, ON Canada.

Signature of Applicant - * Please ensure your signature matches the one on the ID provided * (Required)

* If necessary you can click the "X" in the upper right hand corner of the box to reset the field and start over *

Date (Required)

Signed at: (Required)

City & Province/Territory

D. Identification Verification

Witnessing Agent's Name

Identification Verified

Witnessing Agent's Signature

Type of Photo ID Viewed(Government Issued) & Secondary ID

Name and location of the company where information will be stored in Canada:

**Information related to this criminal record check is collected, retained and disclosed in accordance with applicable privacy legislation.**

Please upload an image of your ID*

Drop your file here or click here to upload You can upload up to 1 files.

Please upload an image of your ID*

Drop your file here or click here to upload You can upload up to 1 files.

Name

Apex Pre-Employment Screening Services

FOR CANADA WIDE CRIMINAL BACKGROUND CHECKS

(Acceptable Government Issued) Photo Identification

Primary ID (Must have both a photo and a signature):

Driver’s Licence (issued by Canadian province or territory)
Provincial Photo Card
Health Card
Foreign Driver’s Licence
Canadian Passport
Foreign Passport
Certificate of Indian Status
Federal, Provincial or Municipal Identification Card
Military Family Identification Cad (MFID)

Note: Social Insurance Number’s (SIN) are NOT acceptable for identification purposes.

Secondary ID:

Note: Social Insurance Number’s (SIN) are NOT acceptable for identification purposes.

Secondary ID:

Any of the pieces on the Primary ID list can also be used as secondary ID

Canadian Citizenship Card
Permanent Resident (PR) Card
Canadian National Institute of the Blind (CNIB) Identification Card
Firearms Acquisition Certificate (FAC)
Military Family Identification Card (MFID)
Student card
Library Card
Credit card
ATM card
Household bill
Driver abstract
Liquor age of majority card
High school diploma
University degree with their name on it
Record of employment
T4 Slip
Direct Deposit Slips
Cancelled Cheque
Smart serve card
HBC rewards card ‘
Air Miles Card
Credential Certificate e.g. Welder– Millwright-Electricians, Nursing,
Union Card
Legion Membership Card
Costco Card – (Photo copy side with name and photo)
First Aid Certificate
Military Reserve card
Marriage licence
Birth Registration
Security Guard or P.I. Licence

Anything with your name on it as long as it is pre-printed or embossed and matches the name on the primary government photo ID. The only thing they will not accept is the SIN