POLICE VULNERABLE SECTOR CHECK TO BE COMPLETED BY APPLICANT Date of Request Mailing Address (name, street, city, province, postal code) Please Print Legibly under Each Heading- this is your mailing label 17 /03/_16. TaN trarrasr aes ap Masse Taylor ‘Alice Mary Ft See Tae aa a — a 1199 Harrison Ave iy ie Tea Coe Dara Be Toadies 7 indsor, ON | Female Windsor Ontario Nac 3u4 re a z ‘Adress History — please fl out i residentsicress diffe fom raling addres andlor resided OUTSIDE ofthe Region inthe past 5 Years Serect anne ad # Giese see below) “Apa Gy Frovce Festal Code [Pols Reason (Agency ame peste i) Grestar Essex County District School Deelartion of Criminal Record Attached Tiientfication — one form MUST be Government Issued and inciade applicant's name, date of birth, signature and photo of applicant “DeecflD posse "Birth Certificate Deesbe "92-387931-01 Ty olID. pee Passport Dante 66260760 ‘Contact Information ended Phase a CalPaese 519-890-3710 "The Police Vulnerable Sector Check will inclade the following information asi exists om the date ofthe search: ‘© Criminal convictions from CPIC andlor local databases. Findings of guilt under the Youth Criminal Justice Act within the applicable disclosure period. + Outstanding eatries such as charges and warrants, judicial orders, Peace Bonds, Probation and Prohtition Orders. As pet CPIC policy, information obtained from the Investigative Databank must be confirmed and authorized for release by the coatrbuting agency. + Absolute and Conditional Discharges, within the applicable disclosure period. * In exceptional cases, where it meets the Exceptional Disclosure Assessment, non-conviction dispositions including but not limited to, Withdrawn and Dismissed. ‘+ Not Criminally Responsible by Reason of Mental Disorder. {+ Allrecord suspensions as authorized for release by the Minister of Public Safty. 1. Thereby release and discharge the Windsor Police Sevice wn all members and employees ofthe sad Service fom any and all actions, aims and demands for ammages, los or iajury bowsoeve rising which may Deeafet be susained by rayslf sa resul ofthe disclosure of information by the Police Service. Uhereby ltutbons the Wiodwot Police Service to nqur ino and disclose the reuls of en police records indicating criminal convictions, conditional an absolute discharges, ‘Gustanding criminal charges 0 me and conduct local police contact search with any Police Service in Canada, 2. exrtty that the informatio provided by mela his aplication is tur and coect tothe best of my knowledge and belie. Ihave ead this consent, understand it dasha com ‘Applicant’ Signature Onder Maw ‘TOTAL NUMBER OF PAGES: rv » NOT VALID UNLESS EMBOSSED WITH POLICE SEALPOLICE VULNERABLE SECTOR CHECK | sa Da ioe OMale wFemale 1982-11-08 {Fam copcant rapt ox vob postion wha pee ot oqpaGos apoasRie rt wall emg Se Scan callie or venerable pen DeSpoN pal eS PE Se ‘Pad employment wit School Board - Desils egarting the respacsioes towards Gilien or valserabe persoata)> Daty ciassroom actvibes (aching, monforing, ec), feld ips, and school everts (exra-cumieuiar cubs and spor. Part 3: Consent {Rerby concer ws earch Deng mis Ge socal cra reordered ty Ge Royal nadie Moctnd Poor © God ot fT bare Dost (Sperm of and been gamed a ecrd sspenson fr any ofr semalofsoss that wre edn fe sche the Cramton Records AS ‘ners ats rok f gving this consent ia saspeced of beng te person sare! i crm record fr one of ese foc st i he scbadaie ‘Se Comma Recorcs Ac respect of whch «prom wat greed ond [wal be requested to prove Sager coef iat recrd and har record ay De ‘revi bythe Commoner ofthe Royal Canaan Mout Poise te Sobcate General of Canc, wh say then Gir al or par of formance coos at revert police freee ther ahora boty. That police fee or shard body wil ex dsciee Sot ehrmatce to mel fares cocseat 8 wrsng Soeiosrs of tat Scmanca w fe peron a npmtin eared w abow tat requested tr mfbrmaton, tat infomation wil be ck fat perce oe a, a 7 SESE Vale: 27-08-16 POLICE USE ONLY (Ont box mest be checked for cock ecton) 1 [RESULTS FOR RCMP NATIONAL REPOSITORY CRIMINAL RCORD CHECK AND VULNERABLE SECTOR SCREENING =e Based sly on the amet and dave of birth provided and he criminal rcard informatie decared by ie appease 2a ofthe ROM? Nascul Repostry of Canin Records wchaingpardonot sx otis records. i NOT ident any records | Deh! (Wad be cmmes) an dame of be of he applicant Posktive identification that s criminal recerd docs or dees wet exist at che = Py | RCP National Repository of Criminal Records can only be confirmed by FINGERPRINT comparisan. Deinrs do exist | =e ‘bermeen 2 comvichon being rendered m court, and the demas accessible on the RCMP Nanonal Repossary of Criminal Records Not ail offences are reported © the RCMP Natonal Repository of Criminal Records. } a ee ee sacarmg | RE Nand Rea s(Cooea Renn a ee ney wy ewe mcd ia Se pee ate Be Sd eee Scueecr oan Sia Delge crete scaneaee Gagraieed com ed Geta tog cement | | Cemmtiemet ey prin) | Cem Naninal Repository of Crammed Records. Not sll offences are mparied w the ROMP Natcnal Repostary of Craminal ] tome Sa SS a ES Te RT aE TE CRARAL | Ge BoM Need Reeenny cfc Res a end ina pom neh secre Guat rd Pee | rane rc | Sten ts rl rd ne ns cr RMP Nee Rape Cre crac ct confirmed by fingerprint comparcen As sch, the criminal record mfarmacien dectared by the applicamt ders met comsaitete t | (emtcontemed ty | Cute Cnt Race by tie RCMP. Dts Gat ea tcarece bong ince tea ag | see ages | St Se REP Nal apes Comal Rn etal sor pred we ROAD to Rago sctached pages | Crome! Records This document may wot contain all criminal recerd convictions exmcieted with the applicant | Rone Se ieerpn ah dos fe ied Wy oe ee Some es or CO] capere, | Rope Nene Regen of Cont Ren ied te Sagepees end ty Se pc ew orc eal TICORD | bixgeran eqsael air cone PS Neer Daeg cance aes ene eee | (eatrectty yeas) | ag ecen a ar RAG Nace Rqooy ed hots Nal oe ego SRP Neo | || SESERSS Se | Resp occa tres Ta acca muy oot commana comin end corvccoer amas wh opto T Raa an we a OE oO OE one re | fee RONG Nase Regen o Caneel erty stg pre! =x Geni ore cod NOT be canpedPoaaee recomrere | Msateaten ta cnn tard des rset cot equa spleen SCBDIT FENGERPEINTS st ROU? | Coes | co_| rosmnive-- see acted pages) fr Sem ‘Naame Reposiery of Criminal Recerds by an etherted poe service ar accreted private Sagerprinting company wich | ee pot een dane. Dekes do cast Merwese a cevcoce beng nade! cout aol fe Soa beng ERO | ROP Nena Comma Reors | [NEGATIVE — No mbemanon was reveled at cn be chon! in acre wah faker ews, ROMP poss and LEARN Gunttine for Pate Resort | [OF POLICE VULNERABLE SECTOR SCREENING ONLY Asch of nex offers he wee grated «record suspension wet condacnd No ashomation release CO | Avert of sr atts who were raed nreond suspense was comes fsbo thorn! fr rca Ser scabed paps for Smads Das of oy Gate WRITMT Ip 7B (OT VALID UNLESS EMBOSSED WITH POLICE SEAL ‘Peso memence couse! on it fam is cece parson © he Poe Services Act 4 an is clleant fr Se perpone of processing fas pce mc chek (ens somcrang fis colecoon shook be dvced :Iafrmaon ant Prwary Co-Ortinamr PO Bax 8, Wins, Ons, NEA 6! RS SSE-ETOO KALE