2021-07-28 1050

Date Of Search (yyyy-mm-dd) / Clerk Number

MELISSA GILSON
310-2322 HATCHER DR NE
Medicine Hat, AB T1C 1Z5
 Medicine Hat Police Service
Police Information Check
Vulnerable Sector Check
POLICE INFORMATION CHECK WILL CONTAIN: *As of the date of this Search
* OUTSTANDING ENTRIES, SUCH AS CHARGES AND WARRANTS, JUDICIAL ORDERS, PEACE BONDS, PROBATION AND
PROHIBITION ORDERS
* CRIMINAL CONVICTIONS FROM CPIC AND/OR LOCAL DATABASES AND SUMMARY CONVICTIONS, FOR 3 YEARS WHEN
IDENTIFIED
* ABSOLUTE AND CONDITIONAL DISCHARGES FOR 1 OR 3 YEARS RESPECTIVELY
* FINDINGS OF GUILT UNDER THE YOUTH CRIMINAL JUSTICE ACT WITHIN THE APPLICABLE DISCLOSURE PERIOD
* PENDING CRIMINAL CHARGES
VULNERABLE SECTOR CHECK WILL CONTAIN: *As of the date of this Search
* ALL THAT IS INCLUDED IN Police Information Check and:
* IN VERY EXCEPTIONAL CASES, WHERE IT MEETS THE EXCEPTIONAL DISCLOSURE AGREEMENT, NON-
CONVICTION DISPOSITIONS INCLUDING, BUT NOT LIMITED TO, WITHDRAWN AND DISMISSED This document is not valid unless
* NOT CRIMINALLY RESPONSIBLE BY REASON OF MENTAL DISORDER embossed or stamped with a
* ALL RECORD SUSPENSIONS AS AUTHORIZED FOR RELEASE BY THE MINISTER OF PUBLIC SAFETY Medicine Hat Police Service seal

APPLICANT INFORMATION
GILSON MELISSA TERESA-LYNN
Last Name First Name Middle Name
FLN:LEBLANC Female
Maiden Name or all other last names used Gender (Male/Female/Transgender)
2322 HATCHER DR NE 310
Street (Number and Name) / Rural Route Apt/Unit/Suite/Box #
Medicine Hat AB T1C 1Z5 MEDICINE HAT, ALBERTA
City Province Postal Code Place of Birth (incl. Province)
1981/07/14 melissagilson@hotmail.ca
Date of Birth (yyyy/mm/dd) Email Address
(403) 866-6663 148065-709
Daytime Phone Number Secondary Phone Number Driver's License #

ADDRESSES FOR LAST FIVE (5) YEARS (only if you've lived outside of Medicine Hat)
UNIT 1 1151 BRIDGE ST SE
Street (Number and Name) / Rural Route Apt/Unit/Suite/Box #
MEDICINE HAT AB T1A 1E3
City Province Postal Code

Street (Number and Name) / Rural Route Apt/Unit/Suite/Box #

City Province Postal Code

Street (Number and Name) / Rural Route Apt/Unit/Suite/Box #

City Province Postal Code

DO YOU HAVE A CRIMINAL RECORD TO SELF-DECLARE?

Attached? Yes No
REASON FOR POLICE CLEARANCE CHECK *** Information required in order to verify information
Employment
Reason
BEFORE AND AFTER SCHOOL PROGRAM
Description of the Position
YMCA
Employer or Hiring Agency

VULNERABLE SECTOR RECORD CHECK

Do you require a Vulnerable Sector Check? YES NO If NO, Proceed to PAGE 2
Describe interaction with children LOOKING AFTER CHILDREN AT THE YMCA CENTER
or vulnerable person(s):
APPLICANT INFORMATION
GILSON MELISSA TERESA-LYNN
Last Name First Name Middle Name
WAIVER AND RELEASE
1. I hereby release and discharge the Medicine Hat Police Service and all members and employees of the said Service from any and all actions, claims and demands for
damages, loss or injury howsoever arising which may hereafter be sustained by myself as a result of the disclosure of information by the Police Service. I hereby authorize
the Medicine Hat Police Service to inquire into and disclose the results of any police records indicating criminal convictions, conditional and absolute discharges,
outstanding criminal charges to me and to conduct a local police contact search with any Police Service in Canada.
2. I certify that the information provided by me in this application is true and correct to the best of my knowledge and belief. I have read this consent, understand it and
agree to it in its entirety.

APPLICANT SIGNATURE Date (yyyy/mm/dd)

EIV Authentication Passed [on 2021-Jul-28 10:17:32 am] 2021/07/28

VULNERABLE SECTOR CONSENT (Sign ONLY if requesting a Vulnerable Sector Check to be conducted)
1. I hereby consent to a search being made in the automated criminal records retrieval system maintained by the RCMP to find out if I have been convicted of, and been
granted a pardon for, any of the sexual offences that are listed in the schedule to the Criminal Records Act.

2. I understand that, as a result of giving this consent, if I am suspected of being the person named in a criminal record for one of the sexual offences listed in the schedule
to the Criminal Records Act in respect of which a pardon was granted or issued, I will be requested to provide fingerprints to confirm that record and that record may be
provided by the Commissioner of the RCMP to the Solicitor General of Canada, who may then disclose all or part of the information contained in that record to a Police
Service or other authorized body. That Police Service or authorized body will then disclose that information to me. If I further consent in writing to disclosure of that
information to the person or organization referred to above that requested the verification, that information will be disclosed to that person or organization.

APPLICANT SIGNATURE Date (yyyy/mm/dd)

EIV Authentication Passed [on 2021-Jul-28 10:17:32 am] 2021/07/28

*** POLICE USE ONLY ***

1 - RESULTS OF NAME-BASED CRIMINAL RECORD VERIFICATION
Delays do exist between the conviction being rendered in court, and the details being accessible on the RCMP database. Not all offences are
reported to the RCMP.
Based solely on the name(s) and date of birth provided and the criminal record information declared by the applicant, a search of the
RCMP National Repository of Criminal Records, did NOT identify any records with the name(s) and date of birth of the applicant.
NEGATIVE Positive identification that a criminal record does or does not exist at the RCMP National Repository of Criminal Records can only be
confirmed by FINGERPRINT comparison.

Based solely on the name(s) and date of birth provided and the criminal record information declared by the applicant, a search of the
RCMP National Repository of Criminal Records, has resulted in a POSSIBLE match to a registered criminal record. Positive
POSITIVE identification that a criminal record does or does not exist at the RCMP National Repository of Criminal Records can only be confirmed
(see attached page for details) by FINGERPRINT comparison or through self disclosure. As such, the criminal record information declared by the applicant does NOT
constitute a Certified Criminal Record by the RCMP.

2 - RESULTS OF FINGERPRINT COMPARISON SEARCH 3 - RESULTS OF INVESTIGATIVE 4 - RESULTS OF POLICE VULNERABLE

WITH THE NATIONAL REPOSITORY OF CRIMINAL DATABANK AND LOCAL INDICES SECTOR SCREENING ONLY
RECORDS
NEGATIVE - No information was
Certifies that our search did not identify any records associated A date of birth based search of
revealed that can be disclosed in
with the applicant that may be disclosed in accordance with pardoned sex offender records was
accordance with Federal laws, local and
Federal laws conducted with NEGATIVE results
RCMP policies.
A search identified that the fingerprints submitted by the Based on fingerprints, a search of
POSITIVE - See attached page(s) for
applicant were certified as identical to fingerprints registered pardoned sex offender records was
details
under Criminal FPS number. See attached. conducted with NEGATIVE results

Based on fingerprints, a search of

POSITIVE -Disposition(s), Criminal
pardoned sex offender records was
Not applicable - No fingerprint search conducted. Records, and/or Conviction(s) are on file
conducted with the following POSITIVE
with the Alberta Provincial Courts
results. See attached documents.

SEARCH CONDUCTED
Date of Search Employee #
2021-07-28 1050

IDENTIFICATION and PAYMENT (to be completed for walk-in customers only)

** Two (2) pieces of Government issued, one form MUST include the applicant's name, date of birth, signature and photo
Identification confirmed by: Employee # Fee Received
$ $53.45
Any police record check is current as of the date it is completed. Your completed record check will remain available for 90 days from the date it was completed. Any police record check not
picked up by that date will be destroyed and the MHPS will not reprocess these record checks or refund any fees.