50-05 - Adult Screening Application

Cadets and Junior Canadian Rangers Group Instruction (CJCR Gp Inst)

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CAN PROTECTED B (When completed)

Adult Screening Application

CJCR Gp requires support from various organizations and individuals to assist and support in the delivery of the Cadet Program. To fulfill its legal obligations as responsible for youth, and to support all adults, there is a need to ensure all adults are appropriately screened.

Along with this form, you will need to provide a photocopy of two pieces of government issued identification, one of which must include a photo, and a Canadian Police Records Check (PRC) with the Vulnerability Sector Screening (VSS). Details on how to acquire a VSS will be provided to you by the RCSU.

Privacy Notice

To process your screening application, CJCR Gp requires personal information from you. Only information needed for the purposes of determining your suitability to work with cadets will be requested.

All information collected during this process will be protected and kept confidential in accordance with the Privacy Act and NDSI 27, Classification and Designation of Information.

Application Type

Please select the appropriate option:

• ☐ Initial Application
• ☐ Renewal

Applicant category:

• ☐ Volunteer
• ☐ Civilian Instructor *
• ☐ Reg F
• ☐ P Res
• ☐ DND Employee
• ☐ Civilian contractor (pers)

* Current CAF members are not eligible to apply to CI positions.

Section 1 – Personal Information

First Name:

Surname:

Preferred Name:

Middle Initial(s):

DOB (DD-MM-YYYY):

Address:

City:

Province:

Postal Code:

Phone Number:

E-mail:

Employer (incl address):

Supervisor (incl email):

Corps/Squadron Number (if applicable):

UIC (if applicable):

Primary Duties:

Do you have a child currently participating in the Cadet Program?

• ☐ Yes
• ☐ No

If yes, provide corps/squadron number:

Section 2 – Previous/Current CAF Experience and Cadet Experience

• ☐ Current CAF experience
• ☐ Previous CAF service
• ☐ Previous Cadet experience
• ☐ No previous CAF or Cadet experience (if you checked this box, skip section 2)

Active/previous CAF Experience

Service Number:

Rank (current or on release):

Unit (current or on release):

Unit CO (incl email):

Release Item:

Release Date:

MOSID:

Previous Cadet Experience

Years of Participation:

Element:

Corps/Squadron Number:

Corps/Squadron location:

Section 3 – References

(cannot be a relative or partner/spouse)

First Reference

Name:

Relationship to you:

Phone Number:

E-mail:

Second Reference

Name:

Relationship to you:

Phone Number:

E-mail:

Third Reference

Name:

Relationship to you:

Phone Number:

E-mail:

Section 4 – Personal Declaration

Have you ever been convicted of a criminal offence for which a record suspension has not been granted?

• ☐ Yes
• ☐ No

Do you have previous experience as a volunteer with a youth organization?

• ☐ Yes
• ☐ No

If yes, please provide the following details:

Name of Organization:

Position held as a Volunteer:

Contact Person:

Position:

Phone Number:

E-mail:

I, the undersigned, agree that all information contained within this application is factual and has been completed to the best of my ability. I permit CJCR Gp, or its agents, to contact any of the references listed on my application. I also understand that CJCR Gp reserves the right to accept or decline my services for any reason, except for those prohibited by the Canadian Charter of Rights and Freedoms.

I recognize that the safety and wellbeing of cadets is my foremost responsibility. I hereby agree that I will immediately advise CJCR Gp should I commit or be implicated in any type of activity that could change my status for my PRC or VSS.

Signature:

Date:

For Use by CJCR Gp and/or designated agents only

Minimum Age of 18:

• ☐ Suitable
• ☐ Not Suitable

Interview Completed – Date:

Current/Previous CAF Service Review (includes approval from current CO):

Reference Checks:

• First Reference – Date:
• Second Reference – Date:
• Third Reference (if required) – Date:

PRC/VSS – Date of Completion:

Applicant Status:

• ☐ Approved as CJCR Gp Volunteer
• ☐ Approved as CI
• ☐ Approved as CAF member
• ☐ Not Approved

Signature and Position (RCSU/CJCR Gp Representative):

Date:

CAN PROTECTED B (When completed)