BACKGROUND CHECKS WITH REFERENCE

Employment and background checks – Élite Domo

INSTRUCTIONS

Welcome to the Consent page for your criminal background. Please complete the following form as carefully as possible, making sure to fill all the necessary fields.

When everything is completed, you will receive an email confirming that your consent form has indeed been sent to the concerned persons.

Step 1 of 5

Informed Consent Pre-Employment Screening or Due Diligence
Given names*
Surname last name*
Date of Birth*
YYYY dash MM dash DD
Place of Birth*
City State / Province Country
Gender*
A. Informed consent
A. Informed consent

The following text will be applied by Quali-T HR Services and Solutions (QTHRSS)* acting on behalf of Élite Domo

I hereby give authorization to obtain any of the information mentioned below and to use and/or disclose such resulting information or related information to the requestor of the above-named organization for the purpose of evaluating my application.
- A verification regarding my judicial record (criminal, penal and civil).
- Details regarding my employment history, including employment data verifications from any previous employer(s)/position(s) I have held; including any other pertinent information related to my candidacy;
I understand that these informations will be kept confidentially in accordance with the federal, provincial, territorial and municipal laws, and that after the disclosure of the information, the police services and institutions can not be held responsible for its utilisation, application nor the outreach of the information. will provide a report containing the personal information collected (including information regarding my character, my reputation, my work history). I understand that my personal information will be used only for the purposes mentioned herein and I consent to its collection, use, conservation and communication subject to the provisions of this consent form. I understand that the found information and files disclose by the police services might not concern me and only the fingerprint process can solely identify me.

I attest that to the best of my knowledge, the information provided by me in this authorization document is correct. Before signing this authorization, I have fully informed myself of its content and meaning and have a full understanding of it.
Applicants signature*
Completed and signed at*
City State / Province
Date of signature*
YYYY dash MM dash DD

C. Personal information
Given names*

Surname last name*

Former names

Surname last name at birth

Current Address*
Address Apt / Local / Suite City State / Province ZIP / Postal Code Country

E-mail*

Phone number*
Previous Address
Previous Address(es) Within the Last 5 Years
Previous Address 1
Address Apt / Local / Suite City State / Province ZIP / Postal Code Country

Previous Address 2
Address Apt / Local / Suite City State / Province ZIP / Postal Code Country

D. Declaration of Criminal Record
Information is collected and disclosed in accordance with federal, provincial and municipal laws.

A Declaration of Criminal Record does not constitute a Certified Criminal Record by the RCMP and may not contain all criminal record convictions.

Applicants must declare all convictions for offences under Canadian federal law.

Do not declare the following:

A conviction for which you have received a Record Suspension (formerly pardon) in accordance with the Criminal Records Act;

A conviction where 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;

Any provincial or municipal offence, and;

Any charges dealt with outside of Canada.

Note that a Certified Criminal Record can only be issued based on the submission of fingerprints to the RCMP National Repository of Criminal Records.

Sentence #1
Offence #1

Date of Sentence #1
YYYY dash MM dash DD

Court Location #1

Sentence #2
Offence #2

Date of Sentence #2
YYYY dash MM dash DD

Court Location #2

Sentence #3
Offence #3

Date of Sentence #3
YYYY dash MM dash DD

Court Location #3

Sentence #4
Offence #4

Date of Sentence #4
YYYY dash MM dash DD

Court Location #4

Sentence #5
Court Location #5

Date of Sentence #5
YYYY dash MM dash DD

Offence #5

Sentence #6
Offence #6

Date of Sentence #6
YYYY dash MM dash DD

Court Location #6

Sentence #7
Offence #7

Date of Sentence #7
YYYY dash MM dash DD

Court Location #7

Sentence #8
Offence #8

Date of Sentence #8
YYYY dash MM dash DD

Court Location #8

E. Identification
Please provide 2 LEGIBLE PHOTOCOPIES OF THE IDENTIFICATION MUST BE INCLUDED WITH THE AUTHORIZATION FORM.

THE PRIMARY IDENTIFICATION MUST BE FROM THE FOLLOWING: Driver’s licence (issued by Canadian province or territory); Foreign Driver’s Licence; Canadian Passport; Foreign Passport; Canadian Citizenship Card; Permanent Resident (PR) Card; Certificate of Indian Status; Firearms Acquisition Certificate (FAC); Canadian National; Institute of the Blind (CNIB)Identification Card; Federal, Provincial or Municipal Identification Card; Military Family Identification Card (MFID).

THE SECONDARY IDENTIFICATION CAN BE FROM THE FOLLOWING: Health Card; Birth Certificate; Baptismal Certificate; Hunting Licence; Hospital Card; Immigration papers; Social Insurance Number (SIN); Student Identity Card (as long as name and photo are shown).
FIRST IDENTIFICATION*
Max. file size: 8 MB.
SECONDARY IDENTIFICATION*
Max. file size: 8 MB.

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Saint-Constant, QC, J5A 0W4
Email: info@filaturequali-t.com
Phone: (450) 445-4969
Toll Free: 1 (888) 345-2887
Fax: (450) 444-4963

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BACKGROUND CHECKS WITH REFERENCE

Employment and background checks – Élite Domo

Employment and background checks – Élite Domo

INSTRUCTIONS

Step 1 of 5

Informed Consent Pre-Employment Screening or Due Diligence

A. Informed consent

B. Reference(s)

Reference #1

Reference #2

Reference #3

C. Personal information

Previous Address

D. Declaration of Criminal Record

Note that a Certified Criminal Record can only be issued based on the submission of fingerprints to the RCMP National Repository of Criminal Records.

Sentence #1

Sentence #2

Sentence #3

Sentence #4

Sentence #5

Sentence #6

Sentence #7

Sentence #8

E. Identification