DND 2576-E Form PDF Details

When individuals apply for positions that require a basic police check, especially those involving the well-being of children or vulnerable persons, the DND 2576-E form plays a critical role in ensuring a safe and trustworthy environment. This form serves as a consent mechanism, allowing for the disclosure of criminal information about the applicant to designated authorities or organizations. It meticulously collects personal details such as name, date of birth, telephone numbers, and addresses, to accurately identify the individual consenting to the background check. With spaces dedicated to outlining the nature of the position being applied for and the name of the requesting organization, the form ensures a targeted and relevant check. Consent is explicitly sought for searching police records, convictions, and any significant incident reports, employing comprehensive sources like the Canadian Police Information Centre (CPIC) and the Military Police National Records Centre (MPNRC). Notably, for positions involving authority or trust over vulnerable groups, consent extends to searches within the automated criminal records retrieval system for pardoned sexual offences. This extensive procedure underscores the emphasis on safeguarding vulnerable populations and maintaining the integrity of positions of trust. Moreover, the form includes statements of release, discharging the Canadian Forces and its members from any liability arising from the disclosure process, alongside a confidentiality statement ensuring the sensitive nature of disclosed information is preserved. The DND 2576-E form embodies a meticulous and structured approach to background checks, balancing the need for security with respect for individual privacy and legal protocols.

QuestionAnswer
Form Name DND 2576-E Form
Form Length 2 pages
Fillable? No
Fillable fields 0
Avg. time to fill out 30 sec
Other names dnd forms, d d 5e character sheet pdf editable, dnd form, dnd online character sheet 3 5

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Consent to Disclosure of Criminal Information

Identification of person providing consent:

Surname

 

Given name(s)

Second

 

Third

 

 

 

 

 

 

 

Maiden

Place of birth

Gender

Male

Date of birth (yy-mm-dd)

 

 

 

 

 

 

 

 

 

 

 

Female

 

 

 

 

 

 

 

 

Home

 

Work

 

 

Telephone numbers:

 

 

 

 

 

 

 

 

 

 

Current address and Previous addresses, if any, within the last 5 years (including applicable dates of residence)

 

Reason for consent:

I am applying for a job which requires a basic police check.

I am an applicant for a paid or volunteer position with a person or organization responsible for the well being of one more children or vulnerable persons.

Other:

Description of Position / Job:

Name of Organization / Person:

Signature of organization representative

DND 2576-E (11-2011)

Design: Forms Management 613-957-6899 / 613-957-6906

Formulaire disponible en français - DND 2576-F

Page 1/2

Consent:

For all applications:

I consent to a search of police records, criminal convictions, local indices and other means for significant incidents and/or offences from which a pardon has not been granted and/or outstanding criminal charges of which the Military Police are aware, through consultation with the Canadian Police Information Centre (CPIC) and the Military Police National Records Centre (MPNRC).

The particulars of the subject of this waiver have been verified by photo identification (attach photocopy). If required, fingerprints will be provided for comparison to verify the existence/non-existence of a Criminal Record.

Signature

Date (yy-mm-dd)

For all positions of authority or trust with children or vulnerable persons:

I consent to a search being made in the automated criminal records retrieval system maintained by the Royal Canadian Mounted Police to find out if I have been convicted of, and been granted a pardon for, any of the sexual offences that are listed in the schedule to the Criminal Records Act.

I understand that, as a result of giving this consent, if I am suspected of being the person named in a criminal record for one of the sexual offences listed in the schedule to the Criminal Records Act in respect of which a pardon was granted or issued, that record may be provided by the Commissioner of the Royal Canadian Mounted Police to the Minister of Public Safety for Canada, who may then disclose all or part of the information contained in that record to the Military Police.

The Military Police will then disclose that information to me. If I further consent in writing to disclosure of that information to the person or organization referred to above that requested the verification, that information will be disclosed to that person or organization.

Signature

Date (yy-mm-dd)

I hereby release and forever discharge Her Majesty the Queen, the Military Police, and all members and employees of the Canadian Forces 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 Military Police to me and/or the above named organization. I acknowledge that information so disclosed may be confirmed only by comparison of the fingerprints on file to which the information relates and my fingerprints.

Signature

Date (yy-mm-dd)

Our Records Check:

Failed to reveal any record relating to the above subject. Positive determination that no record exists in another name for this subject can only be made through fingerprint analysis. No fingerprint comparison was conducted for this subject.

There may or may not be a criminal record in existence. Information can only be confirmed by fingerprint comparison.

Note: The existence nor the particulars of any record regarding a young offender will be disclosed

Checked by:

CPIC

SignatureDate (yy-mm-dd)

SAMPIS

SignatureDate (yy-mm-dd)

Other

Signature

Date (yy-mm-dd)

For MPNRC use only

STATEMENT OF CONFIDENTIALITY:

This record and the information contained therein are being provided in confidence and shall not be disclosed to any person other than the person and/or agency indicated.

DND 2576-E (11-2011)

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