Vulnerable Sector Check - Ontario Provincial Police
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2Ontario
Vulnerable Sector Check
Provincial
Police
Personal information contained on this form is collected pursuant to the Police Services Act, s.41 and Federal and Provincial privacy legislation and is collected for the
purpose of processing this Vulnerable Sector Check. Information related to this check will be retained for two years. Questions concerning this collection should be directed
to your local OPP detachment.
This check is to be used by applicants seeking a paid or volunteer position with vulnerable persons. “Vulnerable person" means a person who, because of their age, a
disability or other circumstances, whether temporary or permanent, are (a) in a position of dependence on others; or (b) are otherwise at a greater risk than the general
population of being harmed by a person in a position of authority or trust relative to them, pursuant to the Criminal Records Act.
This check will include the following information as it exists on the date of the search:
RCMP National repository of Criminal Records, including the Pardoned Sex Offender Database - Pardoned criminal convictions as per the Schedule of the Criminal
Records Act, including non sex offences, identified as a result of a Vulnerable Sector Verification search and authorized for release by the Minister of Public Safety
and Emergency Preparedness
Canadian Police Information Centre (CPIC) (Intelligence and Investigative Databanks)
Outstanding entries, such as charges and warrants, judicial orders, Family court restraining orders, Peace Bonds, Probation and Prohibition orders
Absolute and Conditional Discharges (1-3 years) from local police databases
Criminal charges resulting in dispositions and non-conviction including, but not limited to: Stayed, Withdrawn, Dismissed, Not Guilty, and cases of not criminally
responsible by reason of mental disorder as listed on local police indices
Police contacts including but not limited to theft, weapons, sex offences, or violent, harmful or threatening behavior which may or may not have involved a mental
health incident where no charges were laid
Applicant information
Last Name, First Name, and Middle Names
Gender
□
□
Male
Female
Maiden Name or other Last Names used
Name commonly used or other First Names
Street Number and Name or Lot, Conc. And Township
Apt. No.
City, Town or Village
Province/State
Postal/ZIP Code
Date of Birth
Country of Birth
Telephone
E-mail address
(YYYY/MM/DD)
Addresses for the last five (5) years (if different from above)
Street Number and Name or Lot, Conc. And Township
Apt. No.
City, Town or Village
Province/State
Postal/ZIP Code
From (MM/YY)
To (MM/YY)
Street Number and Name or Lot, Conc. And Township
Apt. No.
City, Town or Village
Province/State
Postal/ZIP Code
From (MM/YY)
To (MM/YY)
Street Number and Name or Lot, Conc. And Township
Apt. No.
City, Town or Village
Province/State
Postal/ZIP Code
From (MM/YY)
To (MM/YY)
Street Number and Name or Lot, Conc. And Township
Apt. No.
City, Town or Village
Province/State
Postal/ZIP Code
From (MM/YY)
To (MM/YY)
Street Number and Name or Lot, Conc. And Township
Apt. No.
City, Town or Village
Province/State
Postal/ZIP Code
From (MM/YY)
To (MM/YY)
Purpose of the record check
□
□
□
I am an applicant for a
volunteer position with a person or organization responsible for the well-being of one
paid OR
Agency/organization stamp affixed or letter attached
or more children or vulnerable persons.
Title of employment/volunteer position:
Description and details regarding the responsibilities towards children or vulnerable person(s)
Identification
Name of organization/agency
Identity of applicant has been
□
verified
Telephone
Signature of organization/agency witness
Date
(yyyy/mm/dd)
LE220E (05/2012)
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