- 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.
- 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.
- TO BE RETURNED, AS SOON AS POSSIBLE,
TO THE SUPERVISOR/PRINCIPAL OF THE APPLICABLE SITE
Attachment D-Blank.doc 
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