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LLWL Declaration - Police Records Check

  • MM slash DD slash YYYY
  • MM slash DD slash YYYY
  • I have no criminal charges or 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).
  • By submitting this form I hereby declare that the information provided on this form is accurate as of the date of submission. Providing false or misleading information may result in discipline, loss of position or loss of employment.