criminal records check 0001
( G€nrgl:
Date
tru,FF
of
sa-a
J
lguo /oe-/
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Vgrr*t-rvst b.c
S Vf. Manlne. Dri vg -/-'
Will you be in position
Vulnerabte
-/
r UrrqriJ {SeJ
Postal Code
,.)
of authorlty or trust over Chlldren or Vulnerable People?
Sector;[ No Elyes.'.
VLP 5X?
.
Province
City
Previous address if less than 5 years at current address
Postal Code
Province
Clty
--/
?)aaq.t"l
:.r:t+-.q,:fr'5ro?; A
Address (apt, no., street)
*ii': S*
Drive/s Licence No:
Telephone No.:
Birth (YYYYUMDP)
.
Sign consent on back of form.
hereby request and authorize the Vancouver'Folice Departrnent and its employees (refered. !o collec*ively
a@investigatether.ecordsandinformationinthepossessionofthe.V.P-D-anybtherpolicingagenGyor I am
rtiy- A"t U""E, to aeterririne the existence of any recods and information in which I am refdrred to or which the subject of (refened to oo[ec'tively hereafter as my.'personal information"). direcflv'to the vouno oerson or addli feouester of the vouth,infgrmqtio,,n, The Youth Criminal Justie Acf makes it an offence to
1dual,sconsent.lndividual,scan,however,disclosetheir information.
I agree to submit my fingerprints, if requested by the V.P.D., to assist in verifying my identity or in determining the existence and/or of my persondjnformadon. I understarid these prints will be destroyed when process complete. Hgyveyer'.l direct and agree of my name and "c"Irr"y tn" in"t i"oonai infonnation I am reguesting be.disclosed, can be investigatedand identiffed by the V.P,.D. on the basis
A"i" of d,ir6r only. I understand and agree t6at the V.P.D. cannot and doJs not guarantee the accuracy of my personal information'to
be
disclosed.
PursuanttoprovisionsoftheFreedomoflnformationandProtectionorpWR$Britid[rColumbia,lauthorizetheV.P.D.todisclose
mypersonalinformationto:
ff1:#ff AgencyAddress (no., street,
firui":H
\
, ^r fer€ne gtrh,rEiir'" ,Bm*j,*l\ '(e
TeuE Lahurnurn* D-,{ l\ \ , t.,
\
\
*I: Yattw"
mf
Aggllcy o{
UnAn
5ir",on1J-aU
*Ler-n
apt)
Armonry
rrovnoE
b.c.
Agencymone
d+
nxr.
2t&-718
Postal Code
vL9 5 N2 ot V1rych ,2013-
IMH$;;'*"t
,ssu*--
WAIVER AND RELEASE: ln bonsideration of the VanJouver Police Departmenfs providing the above services in compliance with my ;;q;;1,.;nJ-uv mviigniture below, I release and forever discharge the Vancouver Pblice Deparfnent, Vancower Police Board, City of Vancouver, and-itslmployees oland from all manner of lawsuits and legal ac{ions, including but not limited to claims, demands, damages, actions orrcauses 6f aaion arising orto arise by reason of the'release of the.personal information as I have requested above; beEn contibuted to or occasioned by the negligenie of the said Vancouver Police Department, notwithstanding that the same and its employees and each of them. Vancouver
{
=4h a"v or Signed in the presence of:
VPD
f46rch
ta(./ ?}_-
Employee:
Records of iximlnat conMc.tions fur whldr a pardon has not been granfed. Thls lnformation MAY llOT include' crimlnal convictlons bv ottrer pofde asencies that have not yet been entered ln CEIC CClCECgj!-Ottawa-
Records of all charges regardless of disposition.
We do nol rglerise MotorVehlcle Act information (violation l
tickets)
Police records, inbrmation and details of allegatons of criminal conduc't or of statutory ofiences commttl,ed or
Record
For information about our Release Griteria see www.vpd.& Record Ghecks FAQ
I
ohrr:
COMPLETED BY: PUBLIC SERVICE UNIT.
POLICE DEPARTMENT
Pfione:
coNFrDBNil,LnwoirNAtrOBEILIS1EM^AiBD lynflotnfuBDQ&ESS \YRITTENPERilNONOFTEEI|'LNC0AVBTPOLICADBAttrAEI$
20
l3
Date
tru,FF
of
sa-a
J
lguo /oe-/
n t-
Vgrr*t-rvst b.c
S Vf. Manlne. Dri vg -/-'
Will you be in position
Vulnerabte
-/
r UrrqriJ {SeJ
Postal Code
,.)
of authorlty or trust over Chlldren or Vulnerable People?
Sector;[ No Elyes.'.
VLP 5X?
.
Province
City
Previous address if less than 5 years at current address
Postal Code
Province
Clty
--/
?)aaq.t"l
:.r:t+-.q,:fr'5ro?; A
Address (apt, no., street)
*ii': S*
Drive/s Licence No:
Telephone No.:
Birth (YYYYUMDP)
.
Sign consent on back of form.
hereby request and authorize the Vancouver'Folice Departrnent and its employees (refered. !o collec*ively
a@investigatether.ecordsandinformationinthepossessionofthe.V.P-D-anybtherpolicingagenGyor I am
rtiy- A"t U""E, to aeterririne the existence of any recods and information in which I am refdrred to or which the subject of (refened to oo[ec'tively hereafter as my.'personal information"). direcflv'to the vouno oerson or addli feouester of the vouth,infgrmqtio,,n, The Youth Criminal Justie Acf makes it an offence to
1dual,sconsent.lndividual,scan,however,disclosetheir information.
I agree to submit my fingerprints, if requested by the V.P.D., to assist in verifying my identity or in determining the existence and/or of my persondjnformadon. I understarid these prints will be destroyed when process complete. Hgyveyer'.l direct and agree of my name and "c"Irr"y tn" in"t i"oonai infonnation I am reguesting be.disclosed, can be investigatedand identiffed by the V.P,.D. on the basis
A"i" of d,ir6r only. I understand and agree t6at the V.P.D. cannot and doJs not guarantee the accuracy of my personal information'to
be
disclosed.
PursuanttoprovisionsoftheFreedomoflnformationandProtectionorpWR$Britid[rColumbia,lauthorizetheV.P.D.todisclose
mypersonalinformationto:
ff1:#ff AgencyAddress (no., street,
firui":H
\
, ^r fer€ne gtrh,rEiir'" ,Bm*j,*l\ '(e
TeuE Lahurnurn* D-,{ l\ \ , t.,
\
\
*I: Yattw"
mf
Aggllcy o{
UnAn
5ir",on1J-aU
*Ler-n
apt)
Armonry
rrovnoE
b.c.
Agencymone
d+
nxr.
2t&-718
Postal Code
vL9 5 N2 ot V1rych ,2013-
IMH$;;'*"t
,ssu*--
WAIVER AND RELEASE: ln bonsideration of the VanJouver Police Departmenfs providing the above services in compliance with my ;;q;;1,.;nJ-uv mviigniture below, I release and forever discharge the Vancouver Pblice Deparfnent, Vancower Police Board, City of Vancouver, and-itslmployees oland from all manner of lawsuits and legal ac{ions, including but not limited to claims, demands, damages, actions orrcauses 6f aaion arising orto arise by reason of the'release of the.personal information as I have requested above; beEn contibuted to or occasioned by the negligenie of the said Vancouver Police Department, notwithstanding that the same and its employees and each of them. Vancouver
{
=4h a"v or Signed in the presence of:
VPD
f46rch
ta(./ ?}_-
Employee:
Records of iximlnat conMc.tions fur whldr a pardon has not been granfed. Thls lnformation MAY llOT include' crimlnal convictlons bv ottrer pofde asencies that have not yet been entered ln CEIC CClCECgj!-Ottawa-
Records of all charges regardless of disposition.
We do nol rglerise MotorVehlcle Act information (violation l
tickets)
Police records, inbrmation and details of allegatons of criminal conduc't or of statutory ofiences commttl,ed or
Record
For information about our Release Griteria see www.vpd.& Record Ghecks FAQ
I
ohrr:
COMPLETED BY: PUBLIC SERVICE UNIT.
POLICE DEPARTMENT
Pfione:
coNFrDBNil,LnwoirNAtrOBEILIS1EM^AiBD lynflotnfuBDQ&ESS \YRITTENPERilNONOFTEEI|'LNC0AVBTPOLICADBAttrAEI$
20
l3
