1. RE: OFFENCE DECLARATION




     

     





    RE: OFFENCE DECLARATION

    (FOR ALL TEACHERS CERTIFIED BY THE ONTARIO COLLEGE OF TEACHERS SINCE DECEMBER 31, 1998 AND ALL STAFF AND VOLUNTEERS FOR WHOM THE BOARD HAS PREVIOUSLY COLLECTED A CRIMINAL BACKGROUND CHECK)

     
    NAME:   (PRINT)   
     

    DATE OF BIRTH:     		   

    EMPL. ID# (If applicable):      		 
       
    POSITION/SCHOOL:   
    (as of _______________)

     

    		  


    I DECLARE, since the last criminal background check collected by the Board, or the Ontario College of Teachers, as the case may be, or since the last Offence Declaration given by me to this Board, that:
      
    ____
    I have no criminal convictions under the Criminal Code of Canada, up to and including the date of this declaration, for which a pardon has not been issued or granted under the Criminal Records Act (Canada).

     

    OR

     
    ____
    I have the following conviction(s) under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.


    LIST OF OFFENCES:

     
    Offence:  
    Date:   


     
    Offence:  
    Date:   


     
    Offence:  
    Date:   
     

    Dated at __________________________ this ____ day of ___________________, 20____

     

     
      
    Employee/Volunteer Signature
    Information collected is under the authority of Regulation 521/01, as amended by Regulation 323/03. No information is to be disclosed regarding this Declaration without the consent of the individual, and is accessible only to the Director and/or designate.


     


    TO BE RETURNED, AS SOON AS POSSIBLE, 

    TO THE SUPERVISOR/PRINCIPAL OF THE APPLICABLE SITE

    Back to top