(FOR ALL TEACHERS CERTIFIED BY THE ONTARIO COLLEGE OF TEACHERS SINCE DECEMBER31, 1998 AND ALL STAFF AND VOLUNTEERS FOR WHOM THE BOARD HAS PREVIOUSLYCOLLECTED 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 SignatureInformation 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
Allowed
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