Government of Ontario: Ministry of Community Safety and Correctional Services

Application for Part III (Appointment Procedure in Urgent Circumstances) Appointment

Interprovincial Policing Act, 2009

Information about Officer to be Appointed

Last Name
First Name
Middle Initial
Rank
Badge number

Business Telephone No. (including area code) Extension

Number of Years as a Police Officer
If the officer is a member of a specialized unit, number of years as a member of the unit
Unit No.
Street No.
Street Name
City/Town
Province
Postal Code

Alternate Telephone No. (including area code)

Driver’s License Number
Province of Issue

Previous Appointment as a Special Constable or Police Officer in Ontario

Has the officer to be appointed ever been previously appointed
as a police officer or special constable in Ontario?

Yes No

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?

Yes No If yes, please state the reason(s) and date(s) for the termination(s) or refusal(s):

Appointment Information

New appointment or Renewal
Duration of appointment period requested:
General description of the officer’s duties in Ontario:

Where the officer is expected to perform these duties:

How will the officer be supervised in Ontario:

Assessment of the risks associated with the officer’s duties, including the possibility of the firearms being used:

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

Yes No

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

Yes No

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

Yes No

Has the officer received training with respect to the use of
firearms during the previous 12 months?

Yes No

Is the officer’s training current with respect to motor vehicle
pursuits?

Yes No

IIs the officer’s training current with respect to the use of force?

Yes No

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

Yes No

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

Yes No
If yes, please describe nature of the misconduct, including the dates and any disciplinary measures:

Information of the Extra-Provincial Commander or Designate Requesting the Appointment

Last Name
First Name
Middle Initial
Unit No.
Street No.
Street Name
City/Town
Province
Postal Code

Business Telephone No. (including area code)

Information about the Officer’s Immediate Supervisor

Last Name
First Name
Middle Initial
Unit No.
Street No.
Street Name
City/Town
Province
Postal Code

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:

to command that officer to cooperate with the Special Investigations Unit, as required of a police officer by section 113 of the Police Services Act and by the Conduct and Duties of Police Officers Respecting Investigations by the Special Investigations Unit Regulation, in any investigation in respect of an incident that occurred while the officer was appointed as a police officer in Ontario;
to command that officer to cooperate with an investigation of a complaint or the conduct of a hearing under Part V of the Police Services Act, subject to the officer enjoying the rights or privileges that an Ontario police officer would have in relation to such an investigation or hearing, where the complaint or hearing relates to (i) the actions of the officer, or any other police officer, while the officer was appointed as a police officer in Ontario, or (ii) the operation or investigation that led to this request for an appointment; and
to disclose and provide, to the extent legally permitted, any record, thing, data or information in the possession or under the control of my police force that is requested in relation to an investigation by the Special Investigations Unit or an investigation or hearing regarding a complaint under Part V of the Police Services Act, subject to my police force enjoying the rights or privileges that an Ontario police force would have in relation to such an investigation or hearing, where the investigation or hearing relates to (i) the actions of the officer, or any other police officer, while the officer was appointed as a police officer in Ontario, or (ii) the operation or investigation that led to the making of this request for an appointment.

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:

Name
Signature

Date (yyyy/mm/dd)

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:

Conduct and Duties of Police Officers Respecting Investigations by the Special Investigations Unit Regulation;
Equipment and Use of Force Regulation;
Code of Conduct under the General Regulation;
Suspect Apprehension Pursuits Regulation.

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

Extra-provincial commander or designate:

Name
Signature

Date (yyyy/mm/dd)

The personal information on this form is collected in accordance with the requirements of s. 12 of the Interprovincial Policing Act, 2009, 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 III of the Interprovincial Policing Act, 2009. Questions about the collection of this personal information may be directed to the Local Commander to whom this form is being submitted.

Instructions for Completing

Information about officer to be appointed:

All information must be completed before submission.

Appointment Information:

Professional misconduct: If a finding of serious misconduct has ever been made against the officer, details must be provided as to the nature of the misconduct, the relevant dates and any disciplinary measures taken.

Information about the extra-provincial commander requesting appointment:

All information about the extra-provincial commander and the officer’s current supervisor with the extra-provincial police force must be completed before submission.

Signature:

By signing the application form the extra-provincial commander undertakes to:
- command the officer to cooperate with Ontario’s Special Investigations Unit as a police officer is required to by the Police Services Act and regulations under that Act;
- command the officer to cooperate in relation to an investigation or hearing regarding a complaint under Part V of the Police Services Act; and
- disclose and provide relevant documents in the possession of the extra-provincial commander’s police force that are requested in relation to an investigation by the Special Investigations Unit or an investigation or hearing regarding a complaint under Part V of the Police Services Act.

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