Providing misleading or false information on this application may result in a refusal or cancellation of the security clearance.
Consent may only be given by an individual who has reached the age of majority. Where an applicant is a minor, the signature of a parent, guardian or tutor is mandatory. (See last page for information on the age of majority).
For security clearance purposes under section 4.8 of the Aeronautics Act and the Transportation Security Clearance Program for airport workers and pursuant to Part 5 of the Marine Transportation Security Regulations for maritime facilities workers (hereinafter "security clearance purposes"), I consent to the disclosure by Transport Canada to the Royal Canadian Mounted Police, the Canadian Security Intelligence Service, Citizenship and Immigration Canada and law enforcement agencies, of any and all information provided by me in support of this application. Without limiting the generality of the foregoing, this includes information relating to my date of birth, education, residential history, employment history, and immigration and citizenship status in Canada. I also consent to the disclosure and use of my fingerprints and facial image for identification purposes.
For security clearance purposes, I hereby authorize Transport Canada to seek, verify, assess, collect and retain any and all information relevant to this application including any criminal records and any and all information contained in law enforcement files, including intelligence gathered for law enforcement purposes, and information with respect to my immigration and citizenship status, as well as any and all information that will facilitate the conduct of a security assessment.
For security clearance purposes, I hereby authorize any and all Canadian persons, agencies or government institutions, having information relevant to this application for a security clearance to release such information to Transport Canada to perform security screening assessments in order to determine whether a security clearance should be granted to me.
This consent is given solely for security clearance purposes. Unless cancelled in writing by me and notification is given in writing to Transport Canada, this consent shall remain valid for conducting all the necessary verifications, specified checks, assessments and/or investigations, including any subsequent required verifications, if need be, as well as any requirements for updates.
I certify that all the information set out by me in this application for a security clearance, including any supporting documentation, is true and correct to the best of my knowledge and belief.