Annual Offence Declaration
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Name
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Email
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Date
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Annual Offence Declaration
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Please select all that apply.
2020
Section A
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Please select all that apply.
I have no 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).
I have no charges that are ongoing and have been withdrawn.
I have not been convicted or been granted a pardon for any of the sexual offences that are listed in the schedule to the Criminal Records Act and to my knowledge.
I have never been nor am I currently being investigated for any of the sexual offences that are listed in the schedule to the Criminal Records Act.
Section B
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I have the following convictions* for offences under the Criminal code of Canada for which a pardon under the Criminal Records Act has not been issued or granted
I have the following charges* that are ongoing or have been withdrawn.
I have been convicted or been granted a pardon for the following sexual offences* that listed in the schedule to the Criminal Records Act
I am aware that I am currently being investigated for the following sexual offences* that are listed in the schedule to the Criminal Records Act.
Details provided below for section B
1. Date of Offence DD-MM-YYYY
Charges/Offence
Location
Penalty/Conviction
2. Date of Offence DD-MM-YYYY
Charges/Offence
Location
Penalty/Conviction
I agree to have the above information collected and be kept by NYCBC for a period deemed necessary by the church, with the understanding that it will be kept confidential with access to it limited to the church authorized personnel. I also understand that failure to provide true information will disqualify me from working with children, youth and other vulnerable persons.
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Agree
Date of Agreement DD-MM-YYYY
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Submit
Description
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