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Criminal Record Verification Informed Consent Form

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CRIMINAL RECORD VERIFICATION
Informed Consent Form

MINTZ
GLOBAL SCREENING
CRIMINAL RECORD VERIFICATION
Informed Consent Form

A. Personal Information

Current Home Address

Previous Address(es) Within the Last 5 Years

(attach additional page if necessary)

B. Reason for the Criminal Record Verification

C. Informed Consent

SEARCH AUTHORIZATION – I HEREBY CONSENT TO THE SEARCH OF the RCMP National Repository of Criminal Records based on the name(s), date of birth and where used, the declared criminal record history provided by myself.

POLICE INFORMATION SYSTEM(S) – I HEREBY CONSENT TO THE SEARCH of police information systems, as part of a Police Information Check, which will consist of a search of the following systems (check applicable):

AUTHORIZATION AND WAIVER to provide a confirmation of criminal record or any police information.

I certify that the information set out by me in this application is true and correct to the best of my ability. I consent to the release of the results of the criminal record checks to Mintz Global Screening Inc. and

I hereby release and forever discharge all members and employees of the processing Police Service and the Royal Canadian Mounted Police from any and all actions, claims and demands for damages, loss or injury howsoever arising.

D. Identification Verification

Name and location of the company where information will be stored in Canada: Mintz Global Screening Inc., Montreal, Quebec

**Information related to this criminal record check is collected, retained and disclosed in accordance with applicable privacy legislation. **

CRIMINAL RECORD VERIFICATION
Declaration of Criminal Record Form

Declaration of Criminal Record

This form is required to be filled and attached to your Informed Consent Form for a Criminal Record Verification.

Applicants must declare all convictions for offences under Canadian federal law.

Verified By:

IDENTITY VERIFICATION

All applicants for a criminal record check must provide government-issued identification prior to undergoing a name-based criminal record check.

An applicant must provide copies of two (2) pieces of valid identification.

PHOTO IDENTIFICATION STANDARDS

One of the provided pieces of identification must be one of the following:

• Driver’s Licence or Nexus Card

• Foreign Driver’s Licence

• Photo Health Card

• Canadian Passport

• Foreign Passport

• Canadian Citizenship Card

• Permanent Resident (PR) Card

• Certificate of Indian Status

• Firearms Acquisition Certificate (FAC)

• Federal, Provincial or Municipal Identification Card

• Military Family Identification Card (MFID)

SECONDARY IDENTIFICATION STANDARDS

The second piece of ID can be another photo ID or any of the following:

• Birth Certificate

• Baptismal Certificate

• Hunting Licence

• Fishing Licence

• Outdoors Card

• Hospital Card

• Immigration Papers

• Canadian Blood Donor Card

• Student Identity Card

WITNESS REQUIREMENTS

The witness must personally view the identification provided and ensure that it matches the person signing this form.

The witness must be one of the following:

• An employee of the company for which this background screening is being completed

• A duly authorized and licensed notary public

• An independent arms length witness

Note to Applicant: You may make a request for access to your personal information, a request for correction or any other request for information by sending a written request to Mintz.

Enter text✕

What the Criminal Record Verification Informed Consent Form Is

The Criminal Record Verification Informed Consent Form is a written authorization used to obtain an individual’s agreement to permit background checks that access criminal history records from law enforcement, state repositories, and national databases. It explains what searches will be run, how the information will be used, and any applicant rights related to accuracy and dispute. Employers, licensing agencies, landlords, and volunteer organizations commonly use this form to comply with disclosure and consent requirements before ordering a criminal history check under federal and state law.

Why a Clear Consent Form Matters

Use this form to document informed consent, demonstrate compliance with electronic and consumer-protection laws, and provide a clear record for adverse-action procedures. A properly completed consent form preserves privacy rights and reduces legal risk for organizations conducting background checks.

Why a Clear Consent Form Matters

Who Typically Requests or Signs This Consent

Employers, licensing boards, landlords, volunteer organizations, and educational institutions commonly request this consent when a criminal background check is necessary.

  • Employers — used for pre-employment screening, position-based checks, and conditional-offer screening procedures.
  • Licensing boards — collected for credentialing, regulatory suitability reviews, and professional compliance verification.
  • Housing managers — used in tenant screening to evaluate safety and suitability while documenting consistent policies.

Keep a signed copy for recordkeeping and to support any adverse-action communications required by applicable law or organizational policy.

Essential Elements of a Professional Consent Form

A professional consent form is explicit about scope, data sources, signer rights, authentication, retention, and the process for disputes to ensure legal sufficiency and operational clarity.

Purpose & Scope

Describe precisely which criminal records and jurisdictions will be searched, and whether county, state, and national databases are included to avoid ambiguity.

Search Sources

List the types of databases and providers to be used, for example state repositories, national criminal index checks, and local court records, so the signer understands data sources.

Use & Sharing

Explain how results will be used, who will receive them, and any retention or onward sharing to meet disclosure expectations and privacy safeguards.

Rights & Dispute

Inform signers of rights to dispute inaccurate information, obtain a consumer report (where applicable), and remedies available under consumer protection rules.

Authentication

Specify required signer authentication (ID, email, SMS code, or knowledge-based checks) and any notarization or witness requirements the organization enforces.

Retention & Disposal

State how long the signed consent will be retained, secure storage measures, and the process for secure disposal when records are no longer required.

Step-by-Step: How to Collect Consent and Run a Check

Follow these steps to collect informed consent and initiate a criminal record verification process in compliance with applicable laws.

  • 01
    Gather ID: Collect a government-issued ID and confirm name and DOB.
  • 02
    Explain Scope: Describe which searches will be run and how results are used.
  • 03
    Obtain Signature: Have the individual sign and date the consent before ordering checks.
  • 04
    Initiate Search: Submit the signed consent and identifiers to the screening vendor securely.

Configuring an Online Consent and Screening Workflow

Configure your online workflow to capture consent, authenticate signers, and record an auditable trail for each criminal record request.

Field Configuration
Authentication Method Email plus SMS code or ID credential check
Required Fields Full name, DOB, SSN/ID, current address, signed consent
Conditional Sections Use conditional fields for jurisdictional disclosures or additional authorizations
Audit Trail Enable timestamps, IP addresses, and signing history capture

Platform Capabilities and Integration Considerations

Confirm platform capabilities before e-submission: signer authentication, encryption, conditional fields, and robust retention controls are essential to protect consent records.

  • File Types: PDF, DOCX, HTML support
  • Integrations: Salesforce, NetSuite, Google Workspace
  • Security: TLS 1.2/1.3 in transit; AES-256 at rest

Where to Send and How to Store Signed Consents

Route the signed consent to the background screening vendor, retain a secure copy in the applicant file, and limit access to authorized personnel only.

  • To Vendor: Upload to the vendor portal using secure transfer
  • To HR File: Store a copy in the applicant or employee record
  • For Disputes: Provide a copy when an individual disputes findings
  • For Audits: Maintain a retrievable, auditable record for reviews

Typical Timelines and Processing Expectations

Processing times vary by vendor and jurisdiction; national database checks are fast, while local court or county searches can take substantially longer.

Typical turnaround:

24–72 hours for national and multi-jurisdiction searches

County records:

2–21 days depending on the county search process

Signed consent deadline:

Obtain valid signature before initiating any record searches

Adverse-action window:

Allow time for disclosure and the applicant’s response

Record retention:

Store signed consent per organizational retention schedule

Common Mistakes to Avoid

  • Collecting incomplete identifiers such as missing birth date or partial SSN that prevent accurate matches and delay searches.
  • Failing to disclose the full scope of searches or data sources, which can breach notice requirements and lead to disputes or rescission claims.
  • Using weak signer authentication, such as email-only confirmation, for sensitive checks increases the risk of unauthorized consent.
  • Not retaining a copy or failing to capture an audit trail, which complicates adverse-action defenses and regulatory reviews.

Penalties and Risks of Improper Consent Handling

FCRA Liability: Civil damages and statutory fines
HIPAA Exposure: Penalties if protected health data mishandled
State Penalties: Fines under state privacy or consumer laws
Identity Risk: Exposure of sensitive identifiers increases theft risk
Employment Claims: Wrongful denial or discrimination allegations
Evidence Gaps: Missing records complicate dispute resolution

Formats and Supporting Documents to Keep with the Consent

Provide signed consent copies in standard formats and attach supporting documents so verifiers and auditors can reproduce the record reliably during reviews.

PDF Archive

Save a PDF version that includes the visible signature, embedded audit trail, and any attachments so it can be reproduced and presented as evidence.

Editable Copy

Keep an editable DOCX or original form template for administrative updates, but always preserve the signed PDF as the primary record of consent.

Audit Package

Retain the audit trail showing timestamps, signer IP or authentication method, and a certificate of completion generated by the eSignature platform.

Attachments

Include copies of identity documents, disclosures given to the signer, and any vendor confirmation receipts with the consent record.

Illustrative Use Cases Across Organizations

These short examples show how consent forms are used in common scenarios to manage risk and document process.

Property Management

A regional property manager collects a signed consent before processing applicant criminal history to maintain consistent tenant screening.

  • The signed consent is stored in the lease application file and tied to the screening vendor record.
  • Keeping a dated consent plus vendor audit trails lets the manager demonstrate consistent screening policy and supports any subsequent adverse-action communications with documented timing and scope.

Healthcare Volunteer Program

A clinic requires volunteers to sign consent before running criminal checks to protect patients and comply with facility policies.

  • Consent covers local and national checks.
  • The clinic retains signed consents in volunteer records, limits access to authorized staff, and includes privacy addenda when screening may touch protected health information.

eSignature Pricing and Capability Comparison

Compare common pricing and capability criteria for widely used eSignature providers. signNow is listed first to align with comparison conventions.

signNow DocuSign Adobe Sign PandaDoc HelloSign
Starting Price $8/user/mo $15/user/mo $14/user/mo $19/user/mo $15/user/mo
Free Trial 7-day free trial, no credit card required Varies by vendor Varies by vendor Varies by vendor Varies by vendor
Bulk Send Yes Yes Yes Yes No
Audit Trail Yes Yes Yes Yes Yes
HIPAA Compliant Yes Yes Yes No No
Envelope Cap No cap 100 envelopes/user/year Varies Varies Varies

Frequently Asked Questions About the Consent Form

Answers to common questions about completing, validating, and storing Criminal Record Verification Informed Consent Forms.


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