Criminal Offence Declaration Download PDF Or complete and submit the form online InstructionsTo be completed by all PPMS coaches who have previously submitted a Criminal Reference Check. This form must be submitted each year you coach. Information submitted will remain confidential and will only be shared with the individual selected to conduct coach screening. Information will not be disclosed to anyone without your written consent. All forms submitted electronically will be deleted once printed and any printed form that discloses criminal charges or convictions will be returned to you once screening is complete.Name* First Last I hereby declare thatChoose the selection that is most appropriateI have no convictions or offences under the Criminal Code of Canada up to and including the date of this declaration for which a pardon has not been issued or granted under the Criminal Records Act (Canada)I have the following convictions for offences under the Criminal Code of Canada for which a pardon under the Criminal Records Act (Canada) has not been issued or granted.ConvictionsI have the following outstanding charges for offences under the Criminal Code of Canada and I am awaiting legal proceedings.Charges pending legal actionConfirmation of Declaration* By checking this box you declare the information provided to be accurate and correct as of this date.