*************************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 CHECK (CRC)
Informed Consent Form
13876366
A. Personal Information
Surname (last name): Bhoj Given names(s): Namita Jayantibhai
Surname (last name) at birth: Former name(s):
Place of birth (City, Province/State, Country): Bhavnagar, India
Date of birth (YYYY-MM-DD): 1996-10-16 Sex: ☐
✘ Female ☐ Male
Phone number(s): 2504151641 Email address: bhojnamita67@gmail.com
Current Home Address
4825
________ Saint kevin
_________________________________________________ 8
__________
✔
Montreal
___________________ Quebec
____________________ H3W1P1
______________
Number Street Apartment City Province/Territory/State Postal/ZIP code

Previous Address(es) Within the Last 5 Years (attach additional page if necessary)
516
________ Anandnagar
_______________________________________________ Shaym
__________ Bhavnagar
___________________ Gujarat
____________________ 364001
______________

________ _______________________________________________ __________ ___________________ ____________________ ______________

B. Reason for the Criminal Record Check (CRC)

Reason for Request (example: Employment – Employer – Job Title): employment
Organization Requesting Search: SSENSE
Contact Name: Lisa Ngo 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
SSENSE
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/NewWestminster/West Vancouver/Treaty
____________________________________________________ SSENSE
Threeand/or
Policeits
Service/Annapolis
agents Toronto, Canada
Royal Police Department , ____________________________.
to __________________________________________________
Name of Processing Police Service Company Name City and Country

Signature of Applicant Date Signed at

Year – Month - Day Quebec
Montreal
2021/10/18 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. **