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Criminal Offence Declaration 23/24
Macdonald Drive Elementary
300C CRIMINAL OFFENCE DECLARATION FORM
Name
Date of Birth
Location/School
Volunteer Position
I DECLARE
, since the last Criminal Reference Check (CRC) provided to the Newfoundland and Labrador English School District (NLESD), or since the last Criminal Offence Declaration (COD) I submitted to the district, that:
I have no convictions under the Criminal Code of Canada up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada).
I have no charges pending under the Criminal Code of Canada up to and including the date of this declaration.
OR
I have the following convictions for offences under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has
not
been issued or granted.
List of Offences
1)
Date of offence
Court Location
Conviction
2)
Date of offence
Court Location
Conviction
3)
Date of offence
Court Location
Conviction
(Use additional form if necessary)
Signature
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