Criminal Record Checks – Morden Police Service

Applicant

Name *

First

Middle

Last

Previous name and/or other names used (nicknames, maiden name, etc.)

Address *

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Phone

Previous addresses if less than 5 years

Identification *

Click or drag files to this area to upload. You can upload up to 2 files.

Applicants must provide two valid pieces of government-issued identification (ID), one of which must include the applicant's name, date of birth, signature, photo and expiry date. Acceptable IDs can be found in our FAQ page

Gender *

Male
Female

Date of Birth *

Place of Birth *

Height *

Weight *

Hair Colour *

Eye Colour *

Marks

Scars

Tattoos

Organization Information

Organization/Company/Firm requesting Police Information Check

Volunteer

Yes
No

Position applied for:

Consent Information

Statement of consent *

I consent to a search of all records available at the time the search is conducted, including charges before the courts, findings of guilt or convictions and court orders registered in my name in the national Repository and local records available to the police service. I understand that if a possible record exists, it will not be disclosed until identification has been confirmed by either myself or by fingerprints.

Waiver for consent of release of information to third party *

I consent to the release of any and all information from available records to the authorized person of the above indicated Organization/Company/Firm.

Consent for persons applying for positions within the vulnerable sector *

Yes
No

If you are an applicant for a paid or volunteer position

(i) With a person or organization responsible for the well-being of one or more children or vulnerable persons, and
(ii) If the position is a position of authority or trust relative to those children or vulnerable persons, please complete the following consent.

Description of the paid or volunteer position *

Provide details regarding the children or vulnerable persons (e.g. age, number of persons, nature of vulnerability, etc.) *

Search Consent *

I consent to a search being made in the automated criminal records retrieval system maintained by the Royal Canadian Mounted Police to determine if I have been found guilty or convicted of and/or have been granted a record suspension for any of the 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, that record may be provided by the Commissioner of the Royal Canadian Mounted Police to the Minister of Public Safety of Canada, who may then disclose all or part of the information contained in that record to a police service or other authorized body. That police service 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.

Declaration of Criminal Record (If applicable) - Completed by Applicant

Note - a Certified Criminal Record can only be issued based on the submission of fingerprints to the RCMP National Repository of Criminal Records.

Important Notices

The confirmation of a declaration of criminal record does not constitute a Certified Criminal Record by the RCMP.
The confirmation of a declaration of criminal record may not contain all criminal record convictions.
This form must be completed in order to receive a copy of the adult criminal convictions and associated information from the RCMP National Repository of Criminal Records.
A Certified Criminal Record can only be issued based on the submission of fingerprints to the RCMP National Repository of Criminal Records.

Criminal Record

A certified Criminal Record is defined as a summary of an individual's offence convictions and non-convictions (where authorized) that are releasable in accordance with Federal laws, based on the results of a Fingerprint-based Criminal Record Verification.

Instructions

Enter name and date of birth exactly as they appear on Morden Police Service form "Consent for the Release of Police Information".
Enter one criminal charge per line.
Identify the date of conviction and place where the offence was committed.

Declare the following information:

All convictions for offences under federal law.

Do not declare the following information:

Absolute discharges or conditional discharges, pursuant to Criminal Code, section 730.
Any charges for which you have received a Pardon, pursuant to the Criminal Records Act.
Any offences while you were a "young person" (12 years old, but less than 18 years old), pursuant to the Youth Criminal Justice Act.
Any charges for which you were not convicted, for example, charges that were withdrawn, dismissed, etc.
Any provincial or municipal offences.
Any charges dealt with outside of Canada.
Any charges for which you received a stay of proceedings.

Offence

Date of Sentence

Location

Certification *

I certify that the information provided is correct to the best of my knowledge.

Date *

Signature *