I give permission to Forrest Green Solutions Ltd., on behalf of the Police Service, to collect my personal information - namely my name(s), gender, address(es), telephone number(s), place of birth, date of birth, current employer (optional), criminal record history (optional) and driver's licence (optional) - and to share it (except for my place of birth and criminal record history, if provided) with a licensed consumer credit reporting agency (e.g. TransUnion) to authenticate my identity when applying online for a police record check. I understand and acknowledge that my personal information (except for my place of birth and criminal record history) will be shared with a consumer credit reporting agency and may update my consumer credit report.

I understand that even if I correctly answer all of the authentication questions, I may still be required to visit the police station. I further acknowledge that the Police Service may require me to complete a finger printing process at additional cost.

I understand and agree that if I abandon the authentication process at any point or do not successfully complete the questions or if the Police Service for any reason determines that my application cannot be completed I will not be refunded the amount already pre-paid.

1. I hereby confirm that I have requested that the Strathroy-Caradoc Police Service perform a Police Record Check on me. I understand that the Strathroy-Caradoc Police Service need to obtain personal information from me that is required to complete the Police Record Check.
2. I hereby authorize the Strathroy-Caradoc Police Service to use the name(s), date of birth, and declared criminal record history I have provided to complete the Police Record Check and disclose such information to me.
3. I understand this includes a search of Strathroy-Caradoc Police Service’s Records Management Systems (“RMS”) and the Canadian Police Information Centre (“CPIC”) database, as maintained by the RCMP.
4. I hereby authorize the Strathroy-Caradoc Police Service to search and release any information listed in section 119 of O. Reg. 155/18 under the Child, Youth and Family Services Act (“CYFSA”) and/or section 16 of O. Reg. 155/18 under the Intercountry Adoption Act (“IAA”), as lawfully required by those Acts.
5. I hereby release and discharge the Strathroy-Caradoc Police Service Board and all employees or agents of Strathroy-Caradoc Police from any and all actions, claims, and demands for damages, loss, or injury howsoever arising which may hereafter be sustained by myself or anyone associated with me as a result of the disclosure of the information to me by Strathroy-Caradoc Police.
6. I hereby authorize Strathroy-Caradoc Police to inquire into and disclose the results of any police records to me, including but not limited to: criminal convictions (summary and indictable), absolute and conditional discharges, findings of not criminally responsible on account of mental disorder, findings of guilt under the Youth Criminal Justice Act (“YCJA”) that are still within the access period listed under section 119(2) of that legislation, any outstanding entries such as charges, judicial orders, probation orders, and prohibition orders, and previous police contact, and to conduct a local police contact search with any other Police Service in Canada.
7. For applicants 18 years of age or older, if my application is for a role that qualifies for a Vulnerable Sector Check under the Criminal Records Act (“CRA”) (i.e. the application is for a paid or volunteer position, and the position is one of trust or authority towards a child or vulnerable person), I hereby consent to a search of the automated criminal records retrieval system maintained by the RCMP to find out if I have been convicted of, and subsequently been granted a record suspension (pardon) for, any sexual offences that are listed in Schedule 2 of the CRA. 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 these sexual offences in respect of which a record suspension was granted, I will be requested to provide fingerprints to confirm that record and that record may be provided by the Commissioner of the RCMP to the Minister of Public Safety, who may then disclose all or part of the information contained in that record to the local police service. The police service 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 I complete this Police Record Check, that information will be disclosed to that person or organization accordingly.
8. I understand that the prescribed fee for the Police Record Check is non-refundable.
9. I certify 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.