Fillable GREATER SUDBURY POLICE SERVICE

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GREATER SUDBURY POLICE SERVICE

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GREATER SUDBURY POLICE SERVICE
DECLARATION OF CRIMINAL RECORD
(To be filled out by Applicant)
This form must be completed in order to receive a name-based Criminal Record, which includes the Adult Criminal
Convictions and associated information from the RCMP National Repository of Criminal Records. Failure to complete
this form accurately will result in an incomplete record check, and require submission of fingerprints to the RCMP
National Repository of Criminal Records.
Last name:
First Name:
Other First Names:
Maiden Names or Other Last Names: Other Names: Date of Birth:
/ /
Gender
Current Street # and name City: Province Postal Code
yyyy/ mm / dd
DECLARATION OF CRIMINAL RECORD
• A declaration of Criminal Record does not constitute a Certified Criminal Record by RCMP
• A declaration of Criminal Record may not contain all criminal record convictions
• A certified Criminal Record can only be issued by Canadian Criminal Real Time Identification Services based on the submission of fingerprints
to the RCMP National Repository of Criminal Records
A declaration MUST include:
• ALL convictions for offences under Federal Law
Declaration must NOT include:
• A conviction in which you have received a Record Suspension (pardon) in accordance with the Criminal Records Act
• A conviction when you were a “young person” under the Youth Criminal Justice Act
• An Absolute or Conditional Discharge, pursuant to section 730 of the Criminal Code
• An offence for which you were not convicted (i.e. the charges were Withdrawn, Dismissed, etc)
• Any Provincial or Municipal offences
• Any charges dealt with outside of Canada
OFFENCE
DATE OF SENTENCE
LOCATION
Applicant Signature Date (yyyy/mm/dd)
Personal information contained on this form is collected and disclosed pursuant to the Municipal Freedom of Information and Protection of Privacy Act, s. 29(1), s. 32
and the Police Services Act, s. 41 for the purpose of processing a police record check. Questions concerning this collection should be directed to the Manager of
Records and Customer Service, Greater Sudbury Police Service, 190 Brady Street, Sudbury, Ontario, P3E 1C7. Telephone: 675-9171 ext. 6243.
(REC16.07/12) Rev. 11/18
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GREATER SUDBURY POLICE SERVICE

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Completed 28 December 2022

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