SEDSI
September 15, 2023
3:39 PM
[link]
The Privacy Act Statement
The information on this form(s) is required for the purpose of providing a security screening assessment. It is collected under the authority of subsection 7(1) of the Financial Administration Act and the Government Security Policy (GSP) of the Government of Canada, and is protected by the provisions of the Privacy Act in institutions that are covered by the Privacy Act. Its collection is mandatory. A refusal to provide information will lead to a review of whether the person is eligible to hold the position or perform the contract that is associated with this Personnel Screening Request. Depending on the level of security screening required, the information collected by the government institution may be disclosed to the Royal Canadian Mounted Police (RCMP) and the Canadian Security Intelligence Service (CSIS), which conducts the requisite checks and/or investigation in accordance with the GSP and to entities outside the federal government (e.g. credit bureaus). It is used to support decisions on individuals working or applying to work through appointment, assignment or contract, transfers or promotions. It may also be used in the context of updating, or reviewing for cause, the reliability status, security clearance or site access, all of which may lead to a re-assessment of the applicable type of security screening. Information collected by the government institution, and information gathered from the requisite checks and/or investigation, may be used to support decisions which may lead to discipline and/or termination of employment or contractual agreements. The personal information collected is described in Standard PIB PSU 917 (Personnel Security Screening) which is used by all government agencies, except the Department of National Defence PIB DND/PPE 834 (Personnel Security Investigation File), RCMP PIB CMP PPU 065 (Security/Reliability Screening Records), CISIS PIB SIS PPE 815 (Employee Security) and PWGSC PIB PWGSC PPU 015 (Personnel Clearance and Reliability Records) used for Canadian Industry Personnel. Personal information related to security assessments is also described in the CSIS PIB SIS PPU 005 (Security Assessments/Advice).
By selecting the "E-Signed by:" radio button and then the SUBMIT button, I do consent to the disclosure of the preceding information, including all the indicated Checks required and my photograph if required, for its subsequent verification and/or use in an investigation for the purpose of providing a security screening assessment. By consenting to the above, I acknowledge that the verification and/or use in an investigation of the preceding information may also occur when the reliability status, security clearance or site access are updated or otherwise reviewed for cause under the Policy on Government Security.
With this consent, I also certify that all the information provided by me on this e-Form is true, correct and complete to the best of my knowledge and belief.
My consent will remain valid until I no longer require a reliability status, a security clearance or a site access clearance, my employment or contract is terminated ,or until I otherwise revoke my consent in writing, to the authorized security official.
*Signature E-signed by:
E-signing the personnel security screening form(s) in OLISS (i.e. both the individual applicant and the responsible Security Official) means copies of the signed form(s) are no longer required to be submitted separately allowing the CSP to move forward without waiting for documentation.
 Original Signature
By selecting this "Original Signature" option, in addition to submitting via OLISS, you must also print, sign and submit copies of all security clearance request form(s) and any required supporting documentation immediately after your online submission. (No change to the current procedure.)
Only individual applicants who have reached the age of majority in their province of residence can sign (i.e. e-sign or with an original signature) their own form(s). Otherwise, receiving the original signatures of both the underage applicant and a parent or guardian is mandatory for processing of the request to proceed.
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