Government of Ontario: Ministry of Community Safety and Correctional Services

Application for Part II (Standard Procedure) Appointment

Interprovincial Policing Act, 2009

Information about Officer to be Appointed





Business Telephone No. (including area code)








Alternate Telephone No. (including area code)


Previous Appointment as a Special Constable or Police Officer in Ontario

Has the officer to be appointed ever been appointed in Ontario as a:

  or  

Appointment Dates (last five years):







Has the officer to be appointed ever had his or her appointment
as a special constable or police officer in Ontario terminated
or refused for cause?

       

Appointment Information

  or  

Duration of appointment period requested:









Will the officer require a designation under section 25.1
of the Criminal Code (Canada)?

  

Are there restrictions on the officer’s ability to perform the duties
in Ontario of which the person making the appointment should
be aware?

  

Is the officer aware of the applicable provisions of the Equipment
and Use of Force Regulation, R.R.O. 1990, Reg. 926?

  

Is the officer aware of the applicable Ontario legislation that the
officer might have to enforce based on the described duties in
Ontario?

  

When was the last date that the officer to be appointed received training for:



Has a finding of serious misconduct ever been made
against the officer?

  

Information of the Extra-Provincial Commander Requesting the Appointment









Business Telephone No. (including area code)

Information about the Officer’s Immediate Supervisor









Business Telephone No. (including area code)

Signature - Undertakings

If the police officer in relation to whom this application is made is appointed as a police officer in Ontario, I undertake to do the following:

The above undertakings continue even after the termination of the appointment of the police officer in relation to whom this application is made.

Extra-provincial commander or designate:




Signature - Acknowledgement of Complete and Accurate Information

I acknowledge that the officer to be appointed will be subject to the Interprovincial Provincial Policing Act, 2009, the Police Services Act, and the following regulations under the Police Services Act:

I have provided information that is accurate and complete to the best to the best of my knowledge.

Extra-provincial commander or designate:




The personal information on this form is collected in accordance with the requirements of s. 4 of the Interprovincial Policing Act, 2009, S.O. 2009, c. 30. It is collected for the purpose of processing a request to appoint an extra-provincial police officer as a police officer in Ontario pursuant to Part II of the Interprovincial Policing Act, 2009. Questions about the collection of this personal information may be directed to the Appointing Official to whom this form is being submitted.

Instructions for Completing

Information about officer to be appointed:

Previous appointment as a special constable or police officer in Ontario:

Appointment Information:

Information about the extra-provincial commander requesting appointment:

Signature:
By signing the application form the extra-provincial commander undertakes to:

These obligations continue even after the officer’s appointment ends.