CONSENT FORM
Criminal/Credit Check Deduction
 
NAME:
  FIRST NAME LAST NAME
SOCIAL INSURANCE #:
 
This is to confirm that I, am aware that a criminal/Credit check will be deducted in my name once a position has been offered to me by Trillium Interim Staffing.

Furthermore, I understand that the total fee for each search is $ 35.00 this amount will be deducted from my first pay cheque that I received from Trillium Interim Staffing.

Employee Signature :
DATE :
TIS Consultant Signature :
DATE :
 
PERSONAL INFORMATION – CONSENT & DISCLOSURE
All of the personal information that is collected by TIS is collected only for the following purposes:

• To establish and maintain your applicant file

• To establish and maintain our employment relationship

• To assist you with your job search

• To assist TIS's clients with finding skilled workers

• To ensure that TIS complies with legal and contractual obligations owed to TIS clients

Your personal information will not be used for any other purpose, not listed above without proper consent. TIS may collect, use or disclose personal information without your consent in exceptional circumstances where such collection, use or disclosure is permitted or required by law.

Third Party Service Providers & Other Third Parties

TIS's policy is not to provide personal information to any third party except in the limited circumstances outlined below.

• Third party Criminal Check service provider: TIS utilizes the services of First Advantage to process criminal reference checks.

• Third party Credit Check service provider: TIS utilizes the services of First Advantage to process credit checks.

• Client Companies: In order to provide client organizations with a superior staffing service and to assist applicants with their job search, TIS must disclose certain applicant/employee information to our Clients.

• WSIB: In order to legally comply with WSIB accident reporting procedures, TIS must supply WSIB with information specific to an individual involved in an accident.

• Emergency Services: In case of an emergency, TIS would disclose the necessary personal information to emergency personnel.

• Law enforcement agencies: TIS would disclose Personal information in case of emergencies, for internal security matters or where required by court order or search warrant.

TIS takes all of the necessary precautions to ensure the safeguarding of your information, whether it is stored electronically or in paper format. Information is stored in secure facilities, protected from unauthorized access and kept only for the time period it is reasonably required.

An employee may withdraw consent at any time, subject to legal or contractual restrictions and reasonable written notice. Employees may contact TIS's Privacy Officer for more information regarding the implications of withdrawing consent.

Name :
DATE :
I, authorize TIS to disclose the following personal information to internal TIS staff, clients, potential clients or third party service providers of TIS for the sole purpose of assisting me with my job search and/or hiring and employing me.

Please initial beside each item to indicate consent.

1. My Name
(Will be disclosed to internal staff, third party service providers & clients)

2. My Address, telephone number & email address
(Will be disclosed to internal staff for the purpose of contacting you & will be disclosed to WSIB only if you have an accident at work)

3. The Region/City where I prefer to work
(Will be disclosed to internal staff & clients)

4. My Work History, Skills & Test Results
(Will be disclosed to internal staff & clients)

5. My Resume
(Will be disclosed to internal staff & clients)

6. My Current Salary & Future Salary expectations
(Will be disclosed to internal staff & clients)

7. My Education History
(Will be disclosed to internal staff & clients)

8. My Date of Birth
(Will be disclosed to the WSIB during the course of reporting if you have had an accident at work)

9. The results of my Reference verifications
(Will be disclosed to internal staff & clients)

10. My completed Consent form to conduct a Criminal Reference Check if this is required for the position in question
(Will be disclosed to internal staff, third party criminal check service provider, and client where required by client)

11. The results of my Criminal Reference Check only if required for the position I am applying
(Will be disclosed to internal staff & clients)

12. My completed Consent form to conduct a search of my Credit History if this is required for the position in question
(Will be disclosed to internal staff, third party credit check service provider & clients)

13. My completed Government of Canada Personnel Screening, Consent and Authorization form only if applying for positions that require Government Clearance in order to be placed
(Will be disclosed to internal staff & Government client for processing)

14. My completed direct deposit form and accompanying blank, voided cheque
(Disclosed to internal TIS staff only for the purpose of processing your pay)

15. My completed timesheet & subsequent payroll records
(Will be disclosed to internal TIS staff only for the purpose of processing your pay & client for the purpose of verifying invoices)

16. A copy of my completed TD1 form
(Will be disclosed to internal TIS staff only for the purpose of processing your pay)

17. My Social Insurance Number
(Will be disclosed to internal TIS staff only for the purpose of processing your pay and to the WSIB during the course of reporting if you have had an accident at work)

18. My responses to interview questions
(Will be disclosed to internal TIS staff only)

19. First Aid Medical Documentation:
(Will be disclosed to; TIS Staffing Solutions, Workplace Safety and Insurance Board (WSIB), Workers Compensation Board (WCB), Workplace Health and Safety Compensation Commission (WHSCC), and La Commission de la sant้ et de la s้curit้ du travail (CSST).)

 
I have reviewed and fully understand the information provided above.

Signature (Applicant/Employee) :
DATE :
Witness Signature :
DATE :
 
Email Address(To whom the pdf wil be mailed)