The RCMP GRC 3584E form serves a crucial purpose in the realm of consent for the disclosure of criminal record information in Canada. By carefully structuring the document into detailed parts, it meticulously outlines the process and requirements for an individual's consent to allow the Royal Canadian Mounted Police (RCMP) to share their personal criminal record information. From capturing basic identification details to specifying the scope of the information to be disclosed, the form navigates through the essential legalities with precision. It empowers individuals to control the sharing of their personal details, ensuring the RCMP adheres to the boundaries of consent provided. The form not only addresses the release and waiver of rights concerning the information disclosed but also sets a validity period for the consent given, enhancing the security and relevance of the data shared. Furthermore, it underscores compliance with the Privacy Act of Canada, highlighting the meticulous balance between individual privacy rights and the necessity for information disclosure in certain contexts. The critical inclusion of parts detailing the types of information accessible, ranging from criminal convictions to more comprehensive police information, and the conditions under which young offender information may be shared, adds a layer of clarity and specificity to the process. This approach aids both the individual providing consent and the entity requesting disclosure in understanding the meticulous nature of accessing and sharing sensitive criminal record information.
| Question | Answer |
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| Form Name | Form Rcmp Grc 3584E |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | GRC, CPIC, form rcmp grc 3584e, REQUESTERS |
Royal Canadian |
Gendarmerie royale |
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CONSENT FOR DISCLOSURE |
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Mounted Police |
du Canada |
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OF CRIMINAL RECORD INFORMATION |
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PART 1 |
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IF COMPLETED MANUALLY, PLEASE PRINT |
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Surname |
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Given name (1) |
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Given name (2) |
Sex |
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Tel. no. (incl. area code) |
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F |
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Address (no., street, apt.) |
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City |
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Province |
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Postal code |
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Date of birth |
Place of birth |
Driver's licence no. |
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Usual first name or alias |
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Maiden name/Any other Surname |
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Previous address if less than 5 years at current address |
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Address (no., street, apt.) |
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Province |
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Postal code |
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PART 2
Pursuant to Section 8(1) of the Privacy Act of Canada, I hereby authorize the Royal Canadian Mounted Police to disclose my personal information to:
Full name |
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Name of organization |
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Address (no., street, apt.) |
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Province |
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PART 3
WAIVER AND RELEASE:
I hereby release and forever discharge Her Majesty the Queen in Right of Canada, the Royal Canadian Mounted Police, their members, employees, agents and assigns from any and all actions, causes of actions, claims and demands for damages, loss or injury, which may hereafter be sustained by myself, howsoever arising out of the above authorized disclosure of information and waive all rights thereto.
PART 4
This consent is valid for a period of three months from the date of signature. |
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Signed this |
day of |
Signature of applicant |
PART 5
Following is information contained in the records of the RCMP or records from other police forces accessible through computer queries and is based on a name and date of birth check only. **A record may or may not exist for the subject of this inquiry, positive identification and a certified criminal records check can only be obtained through a fingerprint check. This can be made with the submission of a complete set of fingerprints to:
INFORMATION AND IDENTIFICATION SERVICES
CANADIAN CRIMINAL RECORD INFORMATION SERVICES 1200 Vanier Parkway
OTTAWA, ONTARIO K1A 0R2
YOUNG OFFENDER INFORMATION - The Youth Criminal Justice Act/Young Offenders Act make it an offence to disclose young offender information. In cases where an adult's record contains young offender information or a young offender requests a copy of his/her criminal record, the criminal record information MUST be given to the requester. Individuals can disclose their own information, but even with consent the RCMP are not legally permitted to disclose young offender information.
INSTRUCTION TO REQUESTERS: The following section contains varying degrees of police information.
-Confirm with the party identified in PART 2, the exact information they require.
-Choose the category which best symbolizes the information you are providing consent for the RCMP to disclose and place your initials in the appropriate INITIALS box.
-The party identified in PART 2 will be advised accordingly of negative checks.
-Checks resulting in possible "hits" for information identified in categories 1, 2 or 3 will require confirmation by the submission of fingerprints.
-You will be required to confirm that information located through the checks stipulated in category 4, is your personal information.
-You may withdraw this consent prior to disclosure.
No. |
Initials |
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Category of Information for Disclosure |
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FOR POLICE USE ONLY |
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Records of criminal convictions found in the Identification Data Bank attainable through the Canadian |
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None |
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** May or |
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Police Information Centre (CPIC) for which a pardon has not been granted. |
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located |
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may not |
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exist |
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RCMP: Make CPIC Criminal Record "LEVEL 1" Query ONLY. |
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Records of criminal convictions attainable through CPIC for which a pardon has not been granted plus |
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None |
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** May or |
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records of outstanding criminal charges which the RCMP are aware of or indicated within the Investigative |
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located |
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may not |
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Data Bank of CPIC. |
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exist |
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RCMP: Make CPIC Criminal Record "LEVEL 1" Query AND a Persons CPIC Query. |
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Records of criminal convictions and summary of police information (including records of outstanding |
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None |
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** May or |
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criminal charges which the RCMP are aware of or indicated within the Investigative Data Bank of CPIC) |
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located |
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may not |
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attainable through CPIC for which a pardon has not been granted plus records of discharges which have |
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3. |
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exist |
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not been removed from the Identification Data Bank in accordance with the Criminal Records Act. This will |
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include all charges regardless of disposition. |
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RCMP: Make CPIC Criminal Record "LEVEL 2" Query AND a Persons CPIC Query. |
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Police information located on computer systems (e.g. Police Information Retrieval System (PIRS), CPIC, |
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None |
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** May or |
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PROS, PRIME, LEIP) and information located through local police indices checks. This will include all |
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located |
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may not |
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information related to non convictions and all charges regardless of disposition. |
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exist |
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4. |
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RCMP: Make Persons Queries on PIRS, CPIC, PROS, PRIME and LEIP. |
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In view of the general nature of this information, confirm with requester this is in fact information pertaining |
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to him/her. Requesters MUST confirm information which pertains to them prior to disclosure. If a |
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discrepancy exists, do not disclose this information. |
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COMPLETED BY |
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Member (signature) |
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Reg. no. |
Unit |
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Date |
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RCMP GRC 3584e