Police Consent to Disclosure Statement
I hereby authorize the London Police Service to conduct a search based on the name(s), date of birth and declared criminal record history, to obtain the information required to complete the police record check and disclose such information to me. This includes a search of the Police Service Records Management System (RMS) and the Canadian Police Information Centre (CPIC) database, maintained by the RCMP. This search of the CPIC database includes a search of the Identification Data Bank (known as the National Repository of Criminal Records), the Investigative Data Bank and the Public Safety Portal (PSP).I hereby release and discharge the London Police Service Board and all members and employees of the London Police Service from any and all actions, claims and demands for damages, loss or injury however arising which may hereafter be sustained by myself as a result of the disclosure of information by the London Police Service. I hereby authorize the London Police Service to inquire into and disclose the results of any police records to me including: outstanding entries, such as charges, judicial orders, peace bonds, probation and prohibition orders; criminal convictions (summary and indictable); absolute and conditional discharges, and to conduct a local police contact search with any police service in Canada.
For Broad Record Check applications, I understand that information will be disclosed beyond what is included in a record check regulated by the Police Record Check Reform Act. This is in accordance with section 119 of O. Reg. 155/18 under the Child, Youth and Family Services Act and section 16 of O. Reg. 200/99 under the Intercountry Adoption Act.
I consent to the release of the following additional records by the London Police Service as part of the Broad Record Check application process:
- Any conviction for which a pardon has been granted where disclosure is authorized under the Criminal Records Act (Canada);
- Outstanding restraining orders issued against me under s. 35 of the Children's Law Reform Act or s. 137 and s. 279.3 of the Child, Youth and Family Services Act.
- All documented interactions between myself and the London Police Service for which there is a written record, unless excluded under section 119(1) of the Child, Youth and Family Services Act.
- Any documented interactions between me and the London Police Service related to actions taken under the Mental Health Act.
- All criminal charges against me that resulted in non-conviction outcomes, including stays of proceedings, dismissals, or withdrawals.