*************************ATTENTION APPLICANT********************

DO NOT SEND THESE FORMS TO Triton Canada Inc.

1. Photocopy 2 pieces of ID - 1 piece must be government issued with your picture and
signature
2. Take the forms that you downloaded from the Triton Canada Inc. Website and the 2 ID
and give/email them to your hiring manager or recruiter

ATTENTION HIRING MANAGER OR RECRUITER

1. Please complete the consent form in section D with signatures and submit it along with
copies of the 2 ID by
a. Uploading into your account on the Triton Canada Inc. Website, www.tritoncanada.ca
b. Email to submit@tritoncanada.ca
c. Fax to 1-866-284-3149

DON’T FORGET
Is the consent form completed in full, signed by the hiring manager/recruiter and the
applicant?
Are the 2 pieces of ID (1 MUST BE GOVERNMENT ISSUED WITH PHOTO) included in the
submission to Triton Canada Inc.?
*Failing to send in a completed consent form and 2 pieces of ID will cause delays in your
check being processed.
If you have any questions regarding this request or any other Triton Canada Inc. service,
please contact our customer service department at: 1-844-874-8667

Yours Truly,

Triton Canada Inc. Customer Service

customerservice@tritoncanada.ca
 CRIMINAL RECORD VERIFICATION
Informed Consent Form
1406946
A. Personal Information
Surname (last name): Frieson-chan Given names(s): Alexander
Surname (last name) at birth: Frieson-Chan Former name(s):
Place of birth (City, Province/State, Country): Victoria, Canada
Date of birth (YYYY-MM-DD): 1999-02-05 Sex (check one) ☐ Female ☐
✘ Male

Phone number(s): 2505801641 Email address: alexanderfriesonchan@gmail.com

Current Home Address
130
________ Niagara Street
_________________________________________________ 1
__________ Victoria
___________________ British Columbia
____________________ V8V1E9
______________
Number Street Apartment City Province/Territory/State Postal/ZIP code

Previous Address(es) Within the Last 5 Years (attach additional page if necessary)
________ _______________________________________________ __________ ___________________ ____________________ ______________

________ _______________________________________________ __________ ___________________ ____________________ ______________

B. Reason for the Criminal Record Verification

Reason for Request (example: Employment – Employer – Job Title): employment
Organization Requesting Search: Randstad - BU 5099
Contact Name: Raj Sra Contact Phone Number:
C. Informed Consent

SEARCH AUTHORIZATION – I HEREBY CONSENT TO THE SEARCH OF the RCMP National Repository of Criminal Records based on the name(s), date of birth and where used,
the declared criminal record history provided by myself. I understand that this verification of the National Repository of Criminal Records is not being confirmed by
fingerprint comparison which is the only true means by which to confirm if a criminal record exists in the National Repository of Criminal Records.

POLICE INFORMATION SYSTEM(S) – I HEREBY CONSENT TO THE SEARCH OF police information systems, as part of a Criminal Record and Judicial Matters Check, which will
consist of a search of the following systems (check applicable):
☐
✘ CPIC investigative Data Bank ☐ Police Information Portal (PIP)

AUTHORIZATION AND WAIVER to provide a confirmation of criminal record or any police information.

I certify that the information set out by me in this application is true and correct to the best of my ability. I consent to the release of the results of the criminal record checks
Triton Canada Inc
to ________________________ Toronto, Canada
, located in ________________________________
Company Name City and Country

I hereby release and forever discharge all members and employees of the processing Police Service and the Royal Canadian Mounted Police from any and all actions, claims
and demands for damages, loss or injury howsoever arising which may hereafter be sustained by myself as a result of the disclosure of information by the
Brockville/Cobourg/OwenSound Police to
________________________________ Service
Triton Canada Inc and/or its agents
__________________________________________________ Toronto, Canada
, ____________________________.
Name of Processing Police Service Company Name City and Country

Signature of Applicant Date Signed at

Year – Month - Day British Columbia
Victoria
2019/04/12 City Province/Territory

D. Identification Verification ☐ Physical Identity Verification ☐ Electronic Identity Verification

Witnessing Agent’s Name: Identification Verified: Yes No

Type of Photo ID Viewed

Witnessing Agent’s Signature:
(Government Issued) & Secondary ID

Triton Canada Inc. - Toronto, Ontario

Name and location of the company where information will be stored in Canada: ____________________________________________________________________________.

**Information related to this criminal record check is collected, retained and disclosed in accordance with applicable privacy legislation. **