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    Jobin MonMar2024

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    Jobin George
    This document is a consent and release of liability form for a student named Jobin George to undergo private security training from Canada Guard Security Inc. The form provides consent for the training entity to collect and share the student's personal information with the Ministry of Community Safety and Correctional Services for licensing purposes. It also releases the training entity and Ministry from liability except for negligence or willful misconduct that results from the collection, use and disclosure of the student's personal information as authorized by the form.

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    © All Rights Reserved
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    Jobin MonMar2024

    Uploaded by

    Jobin George
    7 views1 page
    This document is a consent and release of liability form for a student named Jobin George to undergo private security training from Canada Guard Security Inc. The form provides consent for the training entity to collect and share the student's personal information with the Ministry of Community Safety and Correctional Services for licensing purposes. It also releases the training entity and Ministry from liability except for negligence or willful misconduct that results from the collection, use and disclosure of the student's personal information as authorized by the form.

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    Jobin_MonMar2024

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    This document is a consent and release of liability form for a student named Jobin George to undergo private security training from Canada Guard Security Inc. The form provides consent for the training entity to collect and share the student's personal information with the Ministry of Community Safety and Correctional Services for licensing purposes. It also releases the training entity and Ministry from liability except for negligence or willful misconduct that results from the collection, use and disclosure of the student's personal information as authorized by the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    7 views1 page

    Jobin MonMar2024

    Uploaded by

    Jobin George
    This document is a consent and release of liability form for a student named Jobin George to undergo private security training from Canada Guard Security Inc. The form provides consent for the training entity to collect and share the student's personal information with the Ministry of Community Safety and Correctional Services for licensing purposes. It also releases the training entity and Ministry from liability except for negligence or willful misconduct that results from the collection, use and disclosure of the student's personal information as authorized by the form.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
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    of 1

    Ministry of Community Safety

    and Correctional Services


    Consent and Release of Liability
    Private Security and Investigative Form Regarding Training
    Services Branch
    (This space reserved for office use only)
    Please print or type in black ink
    Student Information
    Important: You must provide your full legal name, as it appears on the identification you are carrying with you to the test venue on the
    test day.
    Last Name First Name Middle Name(s)
    George Jobin
    Other Name(s) (Maiden name, former name, etc. - please specify)

    Address
    Unit No. Street No. Street Name PO Box
    103 102 Silvercreek Parkway North
    City/Town Province Postal Code
    Guelph Ontario N1H7J4
    Business Telephone No. Fax No. Email Address
    5197316452 Ext.
    Mailing Address (Only complete if different from the address noted above)
    Unit No. Street No. Street Name PO Box

    City/Town Province Postal Code

    Date of Birth (yyyy/mm/dd) Gender


    1997-11-23 X Male Female

    I, Jobin George consent to and authorize


    Student Name

    Canada Guard Security Inc


    Name of Training Entity

     to collect personal information from or about me for the purpose of providing training in accordance with the Training and Testing Regulation
    made under the Private Security and Investigative Services Act, 2005 (“PSISA”);
     to disclose personal information collected from or about me, including whether or not I have successfully completed the required training
    under the Training and Testing Regulation, to the Private Security and Investigative Services Branch of the Ministry of Community Safety
    and Correctional Services for the purpose of determining whether I am eligible to be licensed as a security guard or private investigator, and
    for the purpose of administering the licensing system authorized under the PSISA; and
    I also consent to and authorize the Private Security and Investigative Services Branch of the Ministry of Community Safety and Correctional
    Services to disclose personal information collected about me, for the purpose of advising the Ministry’s Test Delivery Vendor as to whether or
    not I have completed the training required under the Training and Testing Regulation; and

    Canada Guard Security Inc


    I hereby release and discharge Her Majesty the Queen in Right of Ontario, the
    Name of Training Entity
    and their respective directors, employees, subcontractors, volunteers, servants and agents, including their successors and assigns, from any
    and all actions, claims and demands for damages, loss or injury, howsoever arising, except as a result of negligence or wilful misconduct which
    may hereafter be sustained by myself as a result of the collection, use and disclosure of personal information as authorized by this form.
    This Release of Liability shall be binding upon and shall ensure to the benefit of my respective heirs, and administrators.
    I certify that I have read the information in this form thoroughly, that I fully understand it, and that by signing below, I have the capacity to
    provide consent, and that I am providing consent freely and voluntarily.
    The information provided is collected under the authority of Section 11 of the Private Security and Investigative Services Act, 2005 for the
    purpose of issuing a licence under the Act. If you have any questions, call a ServiceOntario Customer Service Representative toll-free at 1-866-
    767-7454 (Canada). TTY users call us toll-free at 1-800-268-7095 (TTY Canada). Or mail, Private Security and Investigative Services Branch,
    25 Grosvenor Street, 12th Floor, Toronto ON M7A 1Y6
    Name Signature Date (yyyy/mm/dd)
    JOBIN GEORGE 2024/03/25

    0148E (2014/04) © Queen's Printer for Ontario, 2014 Disponible en français

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