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TORONTO POLICE SERVICE

CRIMINAL RECORD CHECK
SELECT ONE:
CRIMINAL RECORD AND JUDICIAL MATTERS CHECK

$26.72 administrative fee (waived if volunteer letter provided)

To submit your application by mail, please include your completed form, payment (certified cheque/business cheque/money order payable to Toronto
Police Service), and copies of two pieces of government issued identification – both must include applicant’s name, date of birth and signature, and one

TIO ION
must have a photo. Mail to Police Reference Check Program, 40 College Street, Toronto, Ontario M5G 2J3.
TO BE COMPLETED BY APPLICANT
Last name First name Middle name(s)

NS
MANGUKIYA NIRAV RAMESHBHAI
Maiden name/other last name(s) used Other first name(s) used Date of birth (YYYY/MM/DD)

UC AT
(none provided) 1996/12/09
Number and street name Unit number Gender
35-FOUNTAINHEAD ROAD 1714 Male

TR TIC
City Province Postal code
NORTH YORK ON M3J 2V7
Phone number Email address
(416) 994-4093 [email protected]

INS EN
Reason for request
Reason for request (ex. Employment, volunteering, etc.)
Employment / Other
ER UTH
The Criminal Record Check will include the following information as it exists on the day of the search:
• Criminal convictions (summary and/or indictable) from CPIC and/or local databases
• Findings of guilt under the Youth Criminal Justice Act (YCJA) within the applicable disclosure period
The Criminal Record and Judicial Matters Check will include the following information as it exists on the day of the search:
• Criminal convictions (summary and/or indictable) from CPIC and/or local databases
• Findings of guilt under the Youth Criminal Justice Act (YCJA) within the applicable disclosure period
DP -A

• Outstanding entries, such as charges and warrants, judicial orders, peace bonds, probation and prohibition orders
• Absolute and Conditional discharges for 1 or 3 years respectively
Consent
I hereby authorize the Toronto Police Service to conduct a record check of the National Repository of Criminal Records maintained by the RCMP and local
IRE TE

police databases that will be based on the name(s) and date of birth provided by the applicant. I may be required to provide fingerprinting results for
verification purposes.
This screening is not intended for individuals being employed and/or volunteering with Vulnerable* person(s). A more comprehensive process is available
through the Police Reference Check Program for suitable agencies.
QU LE

With the passage of the Police Record Check Reform Act, the Ontario government has clarified that youth records are not to be provided to potential employers. Exceptions
apply when the applicant is employed by or volunteering with a government agency.
*Vulnerable person means a person who, because of their age, a disability or other circumstance, whether temporary or permanent, are (a) in a position of
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dependence on others or (b) are otherwise at a greater risk than the general population of being harmed by person(s) in a position of authority or trust
relative to them.

Applicant’s signature Date (YYYY/MM/DD)

EIV Authentication Error/Thin [on 2024-Jul-16 04:48:58 pm] 2024/07/16
Personal information on this form is collected and disclosed pursuant to the Police Services Act. The Municipal Freedom of Information and Protection of Privacy Act
and the Criminal Records Act and will be used to disclose personal information only to the applicant upon receipt of the applicant’s written consent. Questions should
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be directed to: Police Reference Check Program, 416-808-8244. Additional information is also available on the Service’s website at www.tps.to/police-checks. This
information may or may not pertain to the subject of this inquiry. Positive identification can only be confirmed through submission of fingerprints.

FOR POLICE USE ONLY

Type of identification produced ID number
DL:M0426-59479-61209 EIV Authentication
Type of identification produced ID number
EIV Authentication EIV Authentication
Badge # Initials Fee received
$26.72