LONDON POLICE SERVICE APPLICATION FORM

LONDON POLICE SERVICE
APPLICATION FORM
CONSTABLE CADET
CIVILIAN - Position applied for:
Are you legally eligible to work in Canada
SURNAME
GIVEN NAMES
ADDRESS (Street, P.O. Box, Lot / Concession No.) CITY POSTAL CODE
HOME TELEPHONE NO.
BUSINESS TELEPHONE NO.
HIGHEST GRADE / LEVEL COMPLETED
POST SECONDARY SCHOOL EDUCATION
DO YOU HAVE TYPING / COMPUTER EXPERIENCE NO YES - W.P.M.
BRIEFLY EXPLAIN WHY YOU WOULD LIKE TO BE A MEMBER OF THE LONDON POLICE SERVICE ORGANIZATION:
APPLICANT'S SIGNATURE:
DATE:
NOTE: Individuals who submit false information, or do not meet the requirements, can be disqualified
from further consideration for employment, or dismissed, if already employed.
Notice: Personal information on this form is collected under the authority of the Police Services Act, S38, S43 & S53
and will be used to determine eligibility for employment. Questions about this collection of personal information
should be directed to the address listed below.
NOTE: Persons interested in Constable positions should forward their O.A.C.P. certificate of results and A.T.S.
scoring profile, all formal education mark transcripts / diplomas, four letters of reference, Standard First Aid and
C.P.R. certificates and a complete resume in addition to this application form to;
London Police Service
Human Resources Branch
601 Dundas Street
London, ON
N6B 1X1
Only those selected for an interview will be contacted
Form No. LP 630 (Rev. April, 2010))

AUTHORIZATION FOR THE COLLECTION OF
INFORMATION (POLICE APPLICANT)
I,_______________________________________________________
authorize the London Police Service to collect from any physician, psychologist, employer,
organization or person to whom a signed copy of this authorization or a photocopy or fax thereof
is delivered, to provide any information, opinion, reports. records, documents, or copies thereof
in any form which may be requested in connection with my application for employment with any
police service in Canada, and any subsequent training and employment.
I understand that personal information about me, including but not limited to academic,
employment history including disciplinary records, medical, physical, financial, character, and
criminal record data from sources other than myself will be collected through the selection
process under the authority of Section 43 of the Police Services Act, and with my consent.
I understand that information about me will be used to assess my qualifications and suitability in
relation to my application for employment as a police officer. Any information collected is the
property of the London Police Service.
I consent to the collection, use, disclosure, transmittal and examination by the London Police
Service, or any other police service requesting this material, of all information compiled about
me, including: academic records and transcripts, employment records, police records and history
of law involvement, police service applications, medical information, background and security
checks, financial information including credit bureau check, driving record, physical,
psychological, visual, aptitude, and other employment related tests and interview information
provided during the selection process, training records, and police service performance review
records. I further consent to a criminal record check for a sexual offence for which a pardon has
been granted or issued.
I further understand that any questions I may have concerning the collection, use or disclosure of
this information should be addressed to: Inspector, Personnel Services Branch, London Police
Service, 601 Dundas Street, London, Ontario, N6B-1X1, 519-661-5660.
_____________________
DATE
Form No. LP713 (06/00)
__________________________
SIGNED
__________________________
WITNESS