BSF597 – Commercial Driver Registration Program Application

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Protected B (when completed)

The information you provide in your application, including supporting documentation and biometric data, is collected by the Canada Border Services Agency ("CBSA") and is protected pursuant to both the Customs Act and the Privacy Act. In accordance with Canadian laws and regulations, this information will be shared with other government departments or agencies in Canada for the purpose of the operation of the Commercial Driver Registration Program ("CDRP") and to conduct applicable checks and verifications to determine your
eligibility and continued eligibility in the CDRP. If the required information is not provided, your application may not be processed and the authorization may not be granted.

Individuals to whom the information relates have rights of access to, correction of, and protection of, their personal information under the Privacy Act. The information collected is described in Personal Information Bank # CCRA PPU 042. Instructions for obtaining information are provided in Info Source, which is available at public libraries, government public reading rooms and on the Internet at: http://infosource.gc.ca.

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Personal Information

Mailing address (if different from above)

Have you ever been found in violation of:

Have you ever been found in violation of:

Have you ever been convicted of a criminal offence for which a pardon has not been granted? (Yes/No)

Have you ever been convicted of an alcohol-related driving offence for which a pardon has not been granted? (Yes/No)

If you answered yes to any of these questions, please give details (add additional page if necessary). CBSA may ask for supporting documentation of disposition if required.

I understand that any information gathered for the purposes of this application, including any supporting documentation, background information or biometric data, as well as information obtained from the relevant files of law enforcement agencies, including intelligence gathered for law enforcement purposes, will be used for the purpose of the operation of the CDRP and to conduct applicable checks and verifications to determine eligibility and continued eligibility in the CDRP as described in thePresentation of Persons (2003) Regulations.

In addition, I understand that my personal information gathered for the purposes of this application, including my supporting documentation, background information, biometric data, as well as any other information obtained and collected for the purpose of the operation of the CDRP and to conduct applicable checks and verifications to determine my eligibility and continued eligibility in the CDRP, may be accessed and used by the CBSA, as well as by other government departments or agencies in Canada (including the Royal Canadian Mounted Police and the Canadian Security Intelligence Service), in accordance with the Privacy Act.

If you do not consent to the above-noted collection, use, and sharing of your personal information, your application cannot be processed and an authorization cannot be granted.

Do you consent to the above-noted collection, use, and sharing of your personal information, your application cannot be processed and an authorization cannot be granted? (Yes/No)

Certification

I certify that all information given on this application, and in support of this application, is provided voluntarily and is true, accurate, and complete.

I certify that I have read, understood, and agree to abide by all conditions applicable to the program to which I apply and to the use of the associated authorization, including all instructions and notices accompanying this application.

Do you certify?
Yes/No

Important

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