Employee Fit Proper Declaration

EMPLOYEE FIT PROPER DECLARATION

Personal Information

Position Information

Reporting manager:

Proposed start date:

Fit and Proper Declarations

The employee must truthfully answer the following. For each item checked "Yes", provide a brief explanation in the space provided immediately following the question. A checked box indicates an affirmative response; an unchecked box indicates a negative response.

1. Have you ever been convicted of a criminal offence, received a suspended sentence, or pled guilty to any criminal charge? Yes

2. Have you been the subject of any regulatory sanction, professional disciplinary action, license suspension or revocation, or formal inquiry by a regulatory body? Yes

3. Are there any current civil or criminal proceedings, investigations, or claims pending against you that could reasonably be considered material to your employment? Yes

4. Have you ever been declared bankrupt, entered into insolvency arrangements, or had a personal or corporate bankruptcy petition filed against you? Yes

5. Have you been dismissed or asked to resign from employment for reasons involving misconduct, dishonesty, or breach of professional standards? Yes

6. Do you have any actual or potential conflicts of interest that may affect your duties in the proposed role? (This includes financial interests, close relationships with vendors or clients, or other commitments.) Yes

Employment History (Most recent first)

Employer 1

Employer 2

Education

Graduation date:

Professional References

Provide three professional references who can speak to your suitability for the proposed role.

Reference 1

Reference 2

Reference 3

Legal Disclosures and Statements

At-Will Employment: I understand that, if employed, my employment will be on an at-will basis unless a separate written agreement signed by an authorized officer of the employer states otherwise. Either I or the employer may terminate employment at any time, with or without cause or notice, subject only to applicable law.

Equal Opportunity: The employer provides equal employment opportunity to all applicants and employees without regard to protected characteristics, in accordance with applicable law. Decisions are based on qualifications, merit, and business needs.

Authorization to Verify and Consent

I authorize the employer and its agents to contact prior employers, educational institutions, references, licensing and regulatory authorities, and law enforcement agencies to verify the information provided and to obtain any records or other information relevant to my fitness for the proposed position. I further authorize the release of such information to the employer upon request.

I consent to the employer conducting background checks, credit checks where relevant to the position, and verification of professional licenses or certifications, as permitted by law. I understand that any adverse information discovered may be considered in the employment decision.

Consent to verification: I consent

Applicant Certification and Declaration

I certify that the information provided in this declaration and any attachments is true, complete and correct to the best of my knowledge. I understand that the omission of material facts or the making of false statements may result in denial of employment or, if employed, disciplinary action up to and including termination. I agree to promptly notify the employer in writing of any change to the information provided that may affect my fitness for the role.

Sign Now