# Consent for the Atlantic Police Academy to Conduct a Criminal Record & Background Check

APPLICANT: Please complete Part 1 ONLY , sign and return with your application. Criminal record and background checks will be conducted by the Holland College Atlantic Police Academy (PART 2) on all students prior to admission to the Police Science, Correctional Officer, Conservation Enforcement Off

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| Type | PDF |
| Size | 102 KB |

[Open original PDF →](https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF164.pdf)

Referenced from: [Conservation Enforcement](/programs/conservation-enforcement/)

## Document text

Revision: TWO

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## Consent for the Atlantic Police Academy to Conduct a Criminal Record &amp; Background Check

APPLICANT: Please complete Part 1 ONLY , sign and return with your application. Criminal record and background checks will be conducted by the Holland College Atlantic Police Academy (PART 2) on all students prior to admission to the Police Science, Correctional Officer, Conservation Enforcement Officer, and Sheriff and Public Safety Officer programs. This is in addition to the Criminal Record Check you are required to submit from local police or RCMP with your application.

- I, the undersigned, hereby authorize the Atlantic Police Academy or a police agency to conduct a Records and Background Check with any law enforcement or other agency to determine whether there are criminal convictions, contraventions, charges, court orders or dispositions, or other relevant information recorded.
- I hereby expressly consent to and authorize all such police law enforcement or other agencies to release any information they have on record relating to criminal convictions, contraventions, charges, court orders or dispositions, or other relevant information related to the undersigned.

I further acknowledge that I have read and understood the foregoing consent and authorization.

- [ ] Dated this

day of

,20

(month)

(signature of applicant)

## Part 1: Applicant Details (Please Print/Type Information Clearly)

Full Name of Applicant:

Program Applying For:

Student Number:

(if known)

Maiden Name or previous legal name(s):

Date of Birth:

(month/day/year)

Sex:

Height:

Eye Colour:

Current Address:

Previous Address:

Please provide three names (NOT FAMILY MEMBERS) with contact information (email, phone &amp; mailing address) as additional references for the background check who will be contacted as required:

1.

2.

3.

## COMPLETED BY ATLANTIC POLICE ACADEMY:

Part 2: Results (To Be Completed By Officer Conducting Records and Background Search on behalf of the Atlantic Police Academy)

- [ ] Based on information received there is no record identified. NEGATIVE

There may or may not be a record in existence.

- [ ] POSSIBLE

## DATA SYSTEMS CHECKED:

- [ ] PROS

- [ ] INDICES (PIP)

(Please indicate all systems that were checked)

- [ ] PORS

- [ ] JIS

- [ ] CPIC

- [ ] OTHER

- [ ] VULNERABLE SECTOR CHECK (Mandatory Requirement for Atlantic Police Academy)

Signature of Officer Who Conducted the Checks

Date

Detachment / Department / Service

The personal information requested on this form is collected under the authority of Section 31(c) of the PEI Freedom of Information and Protection of Privacy Act. It will be used for the purpose of managing consent for criminal record and background checks at the Atlantic Police Academy. If you have any questions about the collection or use of this information, please contact Holland College's Chief Privacy Officer at privacy@hollandcollege.com or 902-566-9542, 140 Weymouth St. Charlottetown, PE, C1A 4Z1

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<small>Source: [https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF164.pdf](https://sam.hollandcollege.com/shared/QMS/Forms/QF151-200/QF164.pdf)</small>