CONFIDENTIAL PERSONAL HISTORY FORM FOR THE CIVILIAN SERVICE PROVIDER (Contractor/Contractor’s Employer and Volunteers) This section to be completed by Background Investigators: Approved: Not Approved: Signature Date Background check being completed for the position of: PLEASE READ CAREFULLY PRIOR TO COMPLETING THIS FORM An essential component in the selection process is a background check. A background check will be completed on the Applicant, members of the Applicant’s family and other parties named. As required by Section 29(2) of the Municipal Freedom of Information and Protection of Privacy Act, you are hereby notified that personal information about you is being collected by York Regional Police in order to conduct a background check, which is necessary to the proper administration of the lawfully authorized activities of York Regional Police. All questions must be answered and complete, i.e. dates of birth. All information given will be treated in a confidential manner. All information supplied is subject to verification by investigation. If completing this form by printing, complete in ink. Neatness and legibility are of utmost important. If extra space is required, attach extra pages indicating the area the additional information relates to. An Applicant who is currently residing outside of Canada, must provide: Up to date Criminal Background Clearance Letter; Driver’s License History Check; and Name, address and telephone number of their local police department. Please address any questions concerning the collection of this information to the Requestor identified in Section “A”. Section This section to be completed by the York Regional Police member requesting unsupervised “A” access for the Applicant. (The Requestor of this form should complete Section prior to “A” giving the form to the Applicant). Requestor’s Name: Badge #: Rank/Job Title: District/Bureau/Unit: Period for which access is required (not exceeding one year): Is this a renewal application? No Yes Signature: Checklist for the York Regional Police member requesting the background check: Where will Applicant be assigned? What security access is required? Photocopy of Driver’s License attached: Yes : No If not, indicate why: Is form legible and complete? Yes : No Provide initials here when this form has been reviewed and is complete:
CONFIDENTIAL PERSONAL HISTORY FORM FOR THE CIVILIAN SERVICE PROVIDER (Contractor/Contractor’s Employer and Volunteers) This section to be completed by Background Investigators: Approved: Not Approved: Signature Date Background check being completed for the position of: PLEASE READ CAREFULLY PRIOR TO COMPLETING THIS FORM An essential component in the selection process is a background check. A background check will be completed on the Applicant, members of the Applicant’s family and other parties named. As required by Section 29(2) of the Municipal Freedom of Information and Protection of Privacy Act, you are hereby notified that personal information about you is being collected by York Regional Police in order to conduct a background check, which is necessary to the proper administration of the lawfully authorized activities of York Regional Police. All questions must be answered and complete, i.e. dates of birth. All information given will be treated in a confidential manner. All information supplied is subject to verification by investigation. If completing this form by printing, complete in ink. Neatness and legibility are of utmost important. If extra space is required, attach extra pages indicating the area the additional information relates to. An Applicant who is currently residing outside of Canada, must provide: Up to date Criminal Background Clearance Letter; Driver’s License History Check; and Name, address and telephone number of their local police department. Please address any questions concerning the collection of this information to the Requestor identified in Section “A”. Section “A” This section to be completed by the York Regional Police member requesting unsupervised access for the Applicant. (The Requestor of this form should complete Section “A” prior to giving the form to the Applicant). Requestor’s Name: Badge #: Rank/Job Title: District/Bureau/Unit: Period for which access is required (not exceeding one year): Is this a renewal application? No Yes Signature: Checklist for the York Regional Police member requesting the background check: Where will Applicant be assigned? What security access is required? Photocopy of Driver’s License attached: Yes : No If not, indicate why: Is form legible and complete? Yes : No Provide initials here when this form has been reviewed and is complete:
2018-04-YRP419.docx