Application For Horse Racing Licence And Registration Page 3
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4Gaming Policy and Enforcement Branch
Application for Horse Racing Licence and Registration
SECTION 5 – CONSENT TO RELEASE PERSONAL INFORMATION AND CERTIFICATION
NOTE: Applicants must provide their signature in the space provided below to indicate they understand and agree to the following.
Consent to Release Personal Information (signature required below)
Background Checks and Release of Personal Information
I hereby authorize:
Background checks will include but are not limited to credit history, criminal
record and local indices checks. The Canadian Police Information Centre
1. The Gaming Policy and Enforcement Branch (GPEB) to investigate my
(CPIC) database records will be queried for the disposition of all charges for
suitability for Registration in the gaming industry pursuant to Part 7 and 8
which a person has been fingerprinted (Criminal Record) and all outstanding
of the Gaming Control Act and Gaming Control Regulation. I understand
charges currently before the courts. Local indices checks will be conducted
that GPEB is required to protect the confidentiality and privacy of personal
through the RCMP PIRS, PROS, PRIME and LEIP and any other City,
information provided, in accordance with The Freedom of Information and
Municipal, Provincial, Federal, State, County, Sheriffs, FBI or other police
Protection of Privacy Act (British Columbia).
databases in Canada or the USA that GPEB deems appropriate. These
databases record all complaints the respective police departments investigate
2. Any City, Municipal, or Provincial Police department or public body
and include information related to non convictions and charges regardless of
including GPEB, pursuant to Section 33 of the Freedom of Information and
disposition. Therefore full disclosure of all criminal and civil proceedings is
Protection of Privacy Act (British Columbia), and the Royal Canadian
required and each case will be decided on its own merit. If necessary, an
Mounted Police pursuant to Section 8 (1) of the Privacy Act of Canada, to
applicant will be required to provide fingerprints to verify whether or not they
release any and all personal information and records, (including
have a criminal record.
convictions, non convictions and charges regardless of disposition)
retained by them in their files, including PIRS, CPIC, PROS, PRIME and
You must provide GPEB with the written authorization necessary to allow the
LEIP or any other local indices and databases, and necessary for GPEB to
police or other public bodies to release relevant information including
perform registration and enforcement responsibilities under the Gaming
information relating to the Young Offenders Act to GPEB for the purposes of
Control Act.
registration and enforcement of the Gaming Control Act. The information
requested is collected under the authority of the Gaming Control Act [SBC
3. Any Organization pursuant to Section 6 (2) (a) of the Personal
2002].
Information Protection Act (British Columbia), to disclose my personal
information to GPEB in order for GPEB to conduct a background
investigation in accordance with the Gaming Control Act.
4. GPEB and any Police Departments, Public Bodies or Organizations
noted in paragraphs 2 and 3 above to utilize this consent to conduct any
future background checks and/or release any documents necessary to
continue registration or to approve any subsequent applications, including
electronic applications, submitted to renew registration.
5. GPEB to release my personal identification information (name, date of
birth, address and telephone number) to The Association of Racing
Commissioners International (ARCI) for the purpose of recording race
findings within the horse racing industry in North America.
Certification (signature required below)
I certify that all of the information provided by me in this application for a
horse racing licence/registration is true to the best of my knowledge and
belief.
I understand that any false or inaccurate statements made in this application
for horse racing licence / registration, or failure to disclose may be deemed
sufficient cause for rejection of my application by the Gaming Policy and
Enforcement Branch.
I certify that I have read and understand the conditions of registration
included with this application.
Signature of applicant:
Name: (print your full name)
Effective today: (YYYY-MM-DD)
X
GAMING POLICY AND ENFORCEMENT BRANCH USE ONLY
Application complete
Photo
Fee enclosed
Equifax
CPIC
Interpol
PIRS/PRIME __________
PROS/LEIP
JUSTIN
Online Service
Other ______________________
Date:
Investigator:
Approved
Rejected
Keep your personal information safe. Your completed electronic or paper copy of this form
June 15, 2016
should be stored in a safe and secure place, or destroyed in a secure manner.
Page 3 of 4
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