Clearance Security 330 60E Form PDF Details

In order to ensure the safety of all passengers, airport security personnel require that certain items are placed in your carry-on luggage during the screening process. If you are travelling with any of the following items, be sure to have a Clearance Security 330 60E Form filled out and ready for inspection: Firearms Ammunition Knives (including pocket knives) Scissors Cutting implements (i.e. razor blades, box cutters) Tools (including screwdrivers, hammers, wrenches) Lighters and matches Pets other than service animals accompanying a disabled passenger For a full list of prohibited items and more information on the Clearance Security 330

QuestionAnswer
Form NameClearance Security 330 60E Form
Form Length6 pages
Fillable?No
Fillable fields0
Avg. time to fill out1 min 30 sec
Other namesgovernment of canada security clearance form, tbs forms, 330 tbs, tbs 330 60

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Government

Gouvernement

of Canada

du Canada

SECURITY CLEARANCE FORM

The Privacy Act Statement

PROTECTED (When completed)

OFFICE USE ONLY

Reference number

Department number

File number

 

 

 

The information on this form is required for the purpose of providing a security assessment. It is collected under the authority of subsection 7(1) of the Financial Administration Act and the Government Security Policy (GSP) of the Government of Canada and is protected by the provisions of the Privacy Act in institutions that are covered by the Privacy Act. Its collection is mandatory. A refusal to provide information will lead to a review of whether the person is eligible to hold the position or perform the contract that is associated with this Personnel Screening Request. The information collected by the government institution may be disclosed to the Royal Canadian Mounted Police (RCMP) and the Canadian Security Intelligence Service (CSIS), which conduct the requisite checks and/or investigation in accordance with the GSP and to entities outside the federal government (e.g. credit bureaus). It is used to support decisions on individuals working or applying to work through appointment, assignment or contract, transfers or promotions. It may also be used in the context of updating, or reviewing for cause, the reliability status, security clearance or site access, all of which may lead to a re-assessment of the applicable type of security screening. Information collected by the government institution, and information gathered from the requisite checks and/or investigation, may be used to support decisions, which may lead to discipline and/or termination of employment or contractual agreements. The personal information collected is described in Standard PIB PSU 917 (Personnel Security Screening) which is used by all government agencies, except the Department of National Defence PIB DND/PPE 834 (Personnel Security Investigation File), RCMP PIB CMP PPU 065 (Security/Reliability Screening Records), CSIS PIB SIS PPE 815 (Employee Security), and PWGSC PIB PWGSC PPU 015 (Personnel Clearance and Reliability Records) used for Canadian Industry Personnel. Personal information related to security assessments is also described in the CSIS PIB SIS PPU 005 (Security Assessments/Advice).

Please typewrite or print in block letters.

NOTE: Level I and II must complete sections A to J inclusive and P.

Level III must complete all sections.

A ADMINISTRATIVE INFORMATION (To be completed by Department/Agency/Organization)

 

 

New

 

Upgrade

 

Supplemental

Level

 

I (CONFIDENTIAL)

 

 

III (TOP SECRET)

 

 

 

 

 

 

 

 

 

 

 

 

Update

 

Transfer

 

Re-activation

 

 

II (SECRET)

 

 

other

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Department/Agency/Organization

 

 

 

Employee ID number/PRI/Rank and Service number

 

Organization number

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

B

 

BIOGRAPHICAL INFORMATION (To be completed by the applicant)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1.

Surname (Last name)

2. Full given names (no initials) underline or circle usual name used

3.

Family name at birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4.

All other names used (i.e. Nickname)

 

 

5. Sex

 

6.

Date of

Y

 

M

D

 

 

 

 

 

 

 

 

birth

 

 

 

 

 

 

 

Male

Female

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

7.

Place of birth (city)

 

Province/State

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

8.

Name change (other than marriage)

 

From

 

To

 

 

 

 

 

 

 

9. Place of change (city, province or state, and country)

10. Method (authority)

C SECURITY SCREENING

1.Have you previously completed a Government of Canada security screening form?

Yes

No

If yes, give name of department/agency/organization, and the year and level of clearance.

Y

D MARITAL STATUS/COMMON-LAW PARTNERSHIP

Current status

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Married

 

 

Common-Law Partnership

 

 

 

 

Separated

 

 

Widowed

 

Divorced

 

 

Single

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) CURRENT SPOUSE/COMMON-LAW PARTNER: Surname, given names

B) Maiden Name (if applicable)

 

C) Present citizenship of current spouse/common-law partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D) Date of marriage/

 

 

 

Y

M

D

E) City, province or state, and country of marriage/common-law partnership

 

 

 

 

 

 

 

 

 

 

 

 

 

common-law

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

partnership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

F) City, province or state, and country of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Date of

Y

 

M

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H) Present address (apartment number, street number, street name, civic number (if applicable), city, province or

 

I) If separated,

 

 

 

Y

 

M

D

 

 

 

state and country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

widowed or divorced,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

specify date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

J) Name and address of employer (job title)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) PREVIOUS SPOUSE/COMMON-LAW PARTNER: Surname, given names (cover only the past five years)

B) Present citizenship of former spouse/common-law partner

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) Date of marriage/

Y

 

M

D

D) City, province or state, and country of marriage/common-law partnership

 

 

 

 

 

 

 

 

common-law

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

partnership

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Date of divorce/

Y

 

M

D

F) City, province or state, and country of divorce

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

separation/

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

deceased

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Country of Birth (if known)

 

 

 

 

 

 

 

 

 

H) Date of

 

Y

 

M

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E IMMEDIATE RELATIVES (including those living outside Canada) (see instructions)

NOTE: Do not use initials

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

Y

 

M

D

1

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TBS/SCT 330-60E (Rev. 2006/02)

- 1 -

PROTECTED (When completed)

Surname and full given names

Date of birth

 

Y

 

M

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E IMMEDIATE RELATIVES (continued)

NOTE: Do not use initials

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

 

 

Y

 

M

D

2

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

 

 

Y

 

M

D

3

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

 

 

Y

 

M

D

4

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

 

 

Y

 

M

D

5

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

Y

 

M

D

6

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Full name (surname and all given names, including maiden name)

B) Relationship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) City, province or state, and country of birth

D) Date of

 

 

Y

 

M

D

7

 

birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

E) Present address (apartment number, street number, street name, civic number (if applicable), city, province or state and

F) Date of

Y

 

M

D

 

 

 

country)

death

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G) Name and address of employer

H) Job title

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F CRIMINAL CONVICTIONS IN AND OUTSIDE OF CANADA (see instructions)

Have you ever been convicted of a criminal offence for which you have not

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

been granted a pardon?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, give details. (charge(s), name of police force, city, province/state,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

country and date of conviction)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Charge(s)

 

 

 

 

 

 

 

 

 

 

Name of police force

 

 

 

City

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Province/State

 

 

 

 

 

 

 

 

 

 

Country

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Date of conviction

 

 

 

Y

M

 

 

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

G

FOR COMPLETION BY PERSONS BORN OUTSIDE CANADA OR BORN IN CANADA HOLDING DUAL CITIZENSHIP (see instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Date of entry into Canada

 

 

 

Y

 

M

D

2. Present citizenship

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3. If you are a naturalized Canadian, give the certificate number and date

4. If you are not naturalized, have you

Yes

 

 

Date of application

 

 

 

 

 

 

of issue

 

 

 

 

 

 

 

 

 

 

 

applied for Canadian citizenship? Please

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

M

D

 

 

 

 

 

Y

M

 

 

D

 

 

 

 

 

 

 

provide copy of Immigrant Visa or Record

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Certificate No.

 

 

 

 

 

 

 

 

 

 

 

 

of Landing documentation

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Do you maintain citizenship of a country other than Canada?

 

 

 

 

 

6. Have you used a passport other than a Canadian one?

 

 

 

 

 

 

If yes, please provide the name of the country and explain why.

 

Yes

No

 

If yes, explain why.

 

 

 

 

 

 

 

Yes

 

 

No

(If yes) Name of Country:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(If yes) Explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Explain:

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TBS/SCT 330-60E (Rev. 2006/02)

- 2 -

PROTECTED (When completed)

Surname and full given names

 

 

Y

 

M

D

 

Date of birth

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

H RESIDENCE (there should be no gaps)

List addresses where you have lived during the last 10 years, starting with the most current. (Rural address to include lot and civic number.)

 

Apartment

Street number

Street name

 

Civic number

 

 

 

From

 

 

To

 

 

1

number

 

 

 

 

(if applicable)

 

Y

 

 

M

 

 

present

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

Province or state

Postal code

Country

Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apartment

Street number

Street name

 

Civic number

 

 

 

From

 

 

To

 

 

2

number

 

 

 

 

(if applicable)

 

Y

 

 

M

 

Y

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

Province or state

Postal code

Country

Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apartment

Street number

Street name

 

Civic number

 

 

 

From

 

 

To

 

 

3

number

 

 

 

 

(if applicable)

 

Y

 

 

M

 

Y

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

Province or state

Postal code

Country

Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apartment

Street number

Street name

 

Civic number

 

 

 

From

 

 

To

 

 

4

number

 

 

 

 

(if applicable)

 

Y

 

 

M

 

Y

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

Province or state

Postal code

Country

Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Apartment

Street number

Street name

 

Civic number

 

 

 

From

 

 

To

 

 

5

number

 

 

 

 

(if applicable)

 

Y

 

 

M

 

Y

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

City

 

 

Province or state

Postal code

Country

Telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I EMPLOYMENT (last 10 years) (see instructions for self-employed and consultants) (there should be no gaps)

Would your employment be jeopardized if your current supervisor, below, is contacted?

Yes

No

If yes, provide the name of an alternate employment contact and telephone number.

Were you dismissed or asked to resign from any position(s) as listed below?

 

Yes

 

 

 

 

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

If yes, give name of

employer, supervisor, and date.

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name of employer

 

Supervisor

 

 

Position title

 

 

 

 

 

 

 

 

Date

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Name of employer - do not use initials (department/organization/agency, if applicable)

 

 

B)

 

 

Y

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

 

 

To

 

 

 

present

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) Job-site address (street number, street name, city, province or state and country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D) Job title/Description

 

 

E) Rank and service number (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F) Supervisor's name in full

 

 

 

 

 

 

 

 

G) Supervisor's telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Name of employer - do not use initials (department/organization/agency, if applicable)

 

 

B)

 

 

Y

 

M

 

 

 

 

Y

M

 

 

 

 

 

 

From

 

 

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) Job-site address (street number, street name, city, province or state and country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D) Job title/Description

 

 

E) Rank and service number (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F) Supervisor's name in full

 

 

 

 

 

 

 

 

G) Supervisor's telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Name of employer - do not use initials (department/organization/agency, if applicable)

 

 

B)

 

 

Y

 

M

 

 

 

 

Y

M

 

 

 

 

 

 

From

 

 

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) Job-site address (street number, street name, city, province or state and country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D) Job title/Description

 

 

E) Rank and service number (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F) Supervisor's name in full

 

 

 

 

 

 

 

 

G) Supervisor's telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

A) Name of employer - do not use initials (department/organization/agency, if applicable)

 

 

B)

 

 

Y

 

M

 

 

 

 

Y

M

 

 

 

 

 

 

From

 

 

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

C) Job-site address (street number, street name, city, province or state and country)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

4

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

D) Job title/Description

 

 

E) Rank and service number (if applicable)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

F) Supervisor's name in full

 

 

 

 

 

 

 

 

G) Supervisor's telephone number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

TBS/SCT 330-60E (Rev. 2006/02)

- 3 -

 

Surname and full given names

PROTECTED (When completed)

Date of birth

Y

M

D

 

 

 

 

 

 

 

J

 

FOREIGN EMPLOYMENT

 

 

 

 

FOLLOWING TO BE COMPLETED FOR LEVEL III

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Are you now or have you ever been employed by or

 

If yes, give details (country, organization, nature of work and dates) Include military (cadets), law enforcement and security

 

acted as a consultant for a foreign government, firm, or

intelligence employment

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

agency?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

SECTIONS "K" TO "O" MUST ALSO BE COMPLETED FOR LEVEL III ONLY

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

K

 

TRAVEL

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List countries visited within the last five years for personal travel and/or non-Government business, other than Canada, the USA and Mexico.

 

 

 

 

 

 

Country

 

 

 

 

 

 

 

Purpose

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

 

 

 

 

 

 

 

 

To

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

 

 

M

 

 

Y

 

 

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

L

 

FOREIGN ASSETS

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Do you have any business, financial or personal assets

 

If yes, list the relevant countries (exclude stocks and mutual funds purchased in Canada)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

outside Canada?

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Yes

No

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

M

CHARACTER REFERENCES IN CANADA (see instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

List three character references (non-family members) and one neighbourhood reference

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name in full (no initials)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationship

 

 

 

 

 

 

Period known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete home address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

 

 

1

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete title and business address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name in full (no initials)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationship

 

 

 

 

 

 

Period known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete home address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

 

 

2

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete title and business address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name in full (no initials)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Relationship

 

 

 

 

 

 

Period known

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete home address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

 

 

3

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Complete title and business address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

Neighbourhood reference (see instructions)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Name in full (no initials)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

Complete home address

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Business Telephone Number

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

N

 

EDUCATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Name of the last school or university you attended

 

2. Student ID number

3. Location of institution

 

 

 

 

 

4. Period of attendance

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

full time

 

 

(if known)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

Y

 

M

To

 

 

 

Y

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

5. Field of study (Diploma or degree obtained)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

O

 

MILITARY SERVICE

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Military service in the Canadian Armed Forces: Regular, Reserves and Sea, Army and Air Cadets (from the period since your 16th birthday).

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Name and last location

 

 

2. Rank and Service no.

 

 

 

3. Period of service

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

From

 

 

 

 

Y

 

 

M

 

To

 

 

Y

M

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

P

 

CERTIFICATION

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I hereby certify that the information set out by me in this document is true and correct to the best of my knowledge and belief.

 

 

 

 

 

 

 

 

 

 

 

 

 

1. Signature

 

 

 

 

 

2. Date

 

 

 

 

3. Telephone (Home)

 

 

 

 

 

 

 

3. Telephone (Business)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Y

M

D

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

(

)

 

 

 

 

 

 

 

 

 

(

 

 

 

)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

ALL INFORMATION SUPPLIED IS SUBJECT TO VERIFICATION BY INVESTIGATION

TBS/SCT 330-60E (Rev. 2006/02)

- 4 -

Government

Gouvernement

of Canada

du Canada

INSTRUCTIONS FOR COMPLETION OF SECURITY CLEARANCE FORM TBS/SCT 330-60E (Rev. 2006-02)

General:

-Once completed this form shall be safeguarded and handled at the level of PROTECTED A.

-If clarification of information is required, a Canadian Government Official may contact the applicant to obtain additional information in order to complete the security screening investigation and an interview of the applicant may be requested.

-This form is to be completed using an automated system or if not available using a typewriter or printing in block letter format in black ink.

-Please read and follow these instructions carefully.

-The original signed copy must be submitted.

-It is important that a copy of the completed questionnaire be retained by the applicant for future reference.

-Incomplete or illegible forms will NOT be considered.

-All names are to be in full (no initials) (Maternal and Paternal or other names used).

-Addresses are to include, where applicable civic or township name and the lot and concession numbers.

-If information is not known or is unavailable please indicate this on the form and on a separate sheet of paper explain the cause of circumstance.

-All dates are to be entered in order of YEAR, MONTH, and DAY as applicable.

-If space allotted in any portion is insufficient please use separate sheet using same format.

Detailed Instructions:

SECTION A

-To be completed by the department, agency or organization.

-"Other" This should be used to identify if the security screening is for Site Access, NATO, SIGINT etc.

SECTION B (Remainder of the form is to be completed by the applicant) - Complete as requested.

SECTION C

- Complete as requested.

SECTION D

"common-law partner'' - in relation to an applicant, means a person who is cohabiting with the individual in a conjugal relationship, having so cohabited for a period of at least one year. This includes persons of the same sex.

-1. includes current spouse and common-law partner as applicable.

-If any person is deceased, date of death and last address while living are to be shown.

-2. includes previous spouse and common-law partner as applicable during the last five years.

-If a person is deceased, date of death is to be shown in 2e.

-All other questions to be answered as set forth.

SECTION E

-Questions 1 to 8 - experience has shown that incomplete answers to these questions are the most common cause of delay. Please follow the instructions carefully.

-For all security clearance requests all Immediate Relative(s) information must be provided.

-Immediate family includes the following:

-All children 18 years and over that you or your spouse or common-law partner have a parental relationship.

-Your father, mother, brothers, sisters. Include "half" or "step" relatives in this category.

-Your current spouse's or common-law partner's father and mother. Include "half" or "step" relatives in this category.

If any person is deceased, date of death and last address while living are to be shown.

SECTION F

-List only criminal convictions for which a pardon has NOT been granted. Include on a separate attached sheet of paper, if more than one conviction. Applicant must include those convictions outside Canada.

-Offences under the National Defence Act are to be included as well as convictions by courts-martial are to be recorded.

SECTION G

-If a naturalized Canadian, it is important to show the certificate number, date of issue. Attach a photocopy of the certificate.

-If born abroad of Canadian parents, please provide a copy of your Certificate of Registration of Birth Abroad.

-If not a Canadian Citizen indicate if application has been made for Citizenship. In this case, passport or identity card number and particulars should be recorded in box "6". Please provide copy of Immigrant Visa or Record of Landing documentation.

-Questions 5 and 6 - Attach a separate sheet of paper if more space is required. Each sheet must be signed.

SECTION H

-As set forth, ensuring current address is recorded first.

-The Postal code is mandatory for the current address, and if known, for previous addresses.

-For rural area, include civic number or lot, concession and township number.

TBS/SCT 330-60E (Rev. 2006/02)

SECTION I

-Record your present employment first.

-Please note that it may be necessary to contact your present employer.

-Time at school and periods of unemployment are also to be shown; (as well as, secondments, educational leave, and courses of over six months' duration; include supervisor or colleague's name).

-Job-site address is the address where your work is performed and may be different from your employer's address.

NOTE: If you are self-employed or a consultant, or have been self-employed or a consultant, provide the following:

a)Name of employer - give your business name; if not applicable, give your name;

b)No change;

c)Job-site address - give your permanent business address; if not applicable, give your residence address;

d)No change;

e)No change;

f)Supervisor's name - give a name of a person who can verify your employment;

g)No change.

SECTION J

- Is related to determining past employment of security concern. A security official may ask for further details.

SECTION K

-Travel record is for less than six months, if more than this period it is to be recorded as residence in part "H".

-One day visits to countries, such as cruise stopover, do not have to be recorded.

-A security official may ask for details of travel.

-An employee or contractor on Canadian Government business is not required to record details of travel in this section.

SECTION L

- A security official may ask for details in terms of the type of assets and estimated value.

SECTION M

-Character references must be colleagues, peers, and friends who have known you well for over three years and should be able to cover your non-work environment and activities.

-Character references are NOT to include relatives and MUST be residing in Canada.

-Faster processing is facilitated if references listed are in your geographic area.

-Neighbourhood reference is an individual who has known you for over six months preferably at your current address. If not, the individual has been a neighbour during the past five years.

SECTION N

- Complete as requested.

SECTION O

-Question to be answered if not covered in employment section. List last or current unit and dates of total service in the Canadian Armed Forces.

-If more space is required use a separate sheet of paper. Each sheet must be signed.

SECTION P

- Complete as requested.

SUPPLEMENTAL INFORMATION REQUIREMENTS

Persons who have previously completed a SECURITY CLEARANCE and subsequently marry, remarry or commence a common-law partnership are required to submit an original Security Clearance Form with the following parts completed:

For all Security Clearances

Part A - As set forth in each question Part B - As set forth in each question Part C - As set forth in each question Part D - As set forth in each question

Part E - Provide details on parents of new spouse/common-law partner and any children (over the age of 18 years) of the new spouse/common-law partner

Part P - To be signed by person submitting the form

Note: In addition to the above, in those cases where an individual marries or commences a common-law partnership with a Non-Canadian National or Landed Immigrant who has not yet arrived in Canada, the following information is required:

Parts A-D As set forth in each question

Part E - Parents of new spouse/common-law partner, brothers, sisters (include "half and

"step" relatives) and any children (over the age of 18 years) of the new spouse/common-law partner

Part H - For new spouse/common-law partnership

Part I - For new spouse/common-law partnership

Part P - To be signed by person submitting the form

CYCLICAL UPDATE REQUIREMENTS

-Levels I+II (10 year update). Complete all portions of the form as per instructions above.

-Level III (5 year update cycle)

With the exceptions of Parts H and I, where the information required is that which covers the period of time since the last submission of a questionnaire, ALL OTHER parts of the questionnaire must be completed IN FULL.

TBS/SCT 330-60E (Rev. 2006/02)

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Writing segment 1 in 330 60e security clearance form

2. Once the last section is finished, it's time to put in the necessary specifics in DepartmentAgencyOrganization, Employee ID numberPRIRank and, Organization number, B BIOGRAPHICAL INFORMATION To be, Surname Last name, Full given names no initials, Family name at birth, All other names used ie Nickname, Sex, Male, Female, Place of birth city, ProvinceState, Name change other than marriage, and From so you're able to move forward to the next step.

330 60e security clearance form completion process detailed (stage 2)

3. The next part should be rather easy, A CURRENT SPOUSECOMMONLAW PARTNER, B Maiden Name if applicable, C Present citizenship of current, D Date of marriage commonlaw, E City province or state and, F City province or state and, H Present address apartment number, state and country, J Name and address of employer job, G Date of birth, I If separated widowed or divorced, A PREVIOUS SPOUSECOMMONLAW PARTNER, B Present citizenship of former, C Date of marriage commonlaw, and E Date of divorce separation - all these empty fields has to be filled in here.

F City province or state and, E Date of divorce separation, and B Maiden Name if applicable of 330 60e security clearance form

Be really mindful when filling out F City province or state and and E Date of divorce separation, because this is where most users make errors.

4. To move ahead, this next stage requires filling in a handful of blanks. These comprise of G Name and address of employer, F Date of death if applicable, H Job title, and TBSSCT E Rev, which are fundamental to continuing with this particular document.

Step no. 4 for filling in 330 60e security clearance form

5. This very last point to complete this document is critical. Be certain to fill out the necessary blanks, for instance Surname and full given names, E IMMEDIATE RELATIVES continued, A Full name surname and all given, C City province or state and, E Present address apartment number, G Name and address of employer, A Full name surname and all given, C City province or state and, E Present address apartment number, G Name and address of employer, A Full name surname and all given, PROTECTED When completed, Date of birth, B Relationship, and D Date of birth, prior to using the pdf. Failing to do so could end up in a flawed and probably nonvalid paper!

Ways to complete 330 60e security clearance form portion 5

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