Article Structure
The Criminal Report form plays a crucial role in the liquor licensing process in British Columbia, ensuring that applicants are thoroughly vetted for any potential legal issues. This form requires individuals to provide a comprehensive Personal History Summary and grant consent for a criminal record search. It collects essential personal information, including full name, birthdate, and any previous names used. The applicant must disclose their current residence and answer questions about residency in British Columbia, as well as their status as a permanent resident. Furthermore, details regarding any previous liquor license holdings or associations with liquor manufacturers are necessary. The form also addresses recent driving infractions related to alcohol, questions about criminal history, and requires the applicant to submit additional documentation as needed, such as driver's abstracts and statutory declarations. Completion instructions highlight the importance of clarity, whether the form is filled out digitally or by hand. By carefully gathering and assessing this information, the Liquor Control and Licensing Branch aims to uphold public safety and maintain the integrity of liquor distribution in the province.
Criminal Report Example
Personal History Summary and
Consent to Criminal Record Search
Liquor Control and Licensing Form LCLB004
INSTRUCTIONS:
After completing this consent form, please submit it, along with your application and other required documents, to the Liquor Control and Licensing Branch Head Office. You may complete this form at your computer, then print. If you are completing this form by hand, please print clearly using dark ink.
•If you have any questions about completing this form, call the branch
•LCLB forms and supporting materials referred to in this document can be found at: www.pssg.gov.bc.ca/lclb
Location of (proposed) licensed establishment, liquor manufacturer or liquor agency:
StreetCityProvince Postal Code
Legal Entity Name: |
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Licence or Job #: |
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(i.e. sole proprietor, partnership, private corporation, society) |
(not applicable if application is not already in progress) |
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Full Name: |
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Gender (Please check): M |
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(last / first / middle) |
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F 
BIRTHDATE: 
(year / month / day)
Birthplace: 
Last name at birth: 
Other last names used: 
Residence Address: 
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Have you used any other names? (Please check): Yes |
No |
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If yes, please provide name details below: |
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First and middle names at birth: |
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Other first and middle names used: |
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Street |
City |
Province / Country |
Postal Code |
Business Tel with area code: 
Personal Tel with area code: 
Business Fax with area code: 
Business 
1.Do you reside in B.C. for the majority of the year (i.e., more than 6 months)? Yes 
If NO, please provide details of where you reside for the remainder of the year:
No 
2. |
Are you a permanent resident who has resided in Canada for less than the past five years? Yes |
No |
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If yes, attach a copy of your "Record of Landing" (Form IMM1000, Permanent Resident Card or equivalent documentation), as |
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provided by Citizenship and Immigration Canada when you entered the country, and a statutory declaration signed by a lawyer, |
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Notary Public or Commissioner for Taking Affidavits stating that you have not been charged with, discharged, or convicted of a |
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criminal or |
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Canada. (For further information and to review a sample statutory declaration, refer to this LCLB web page: |
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http://www.pssg.gov.bc.ca/lclb/LLinBC/criminal_record_search.htm |
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3. |
Are you either living outside of Canada or a refugee who has been in Canada for less than five years? |
Yes |
No |
If yes, please attach a statutory declaration signed by a lawyer, Notary Public or Commissioner for Taking Affidavits stating that you have not been charged with, discharged or convicted of a criminal or
4. Have you ever held, or do you presently hold, an interest in a liquor licence? |
Yes |
No 
If yes, provide details of licence(s) or application(s): date, location, name of establishment, licence type, current status, etc.):
(Attach a separate sheet to this application if additional space is required.)
5. Do you currently hold a Rural Agency Store appointment from the Liquor Distribution Branch (LDB)? Yes |
No |
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LCLB004 (Last updated 15 May 2012) |
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Personal History Summary and Consent to Criminal Record Search |
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Note: If you are submitting an application for an agent's or manufacturer's licence, please select “N/A” for questions 6 and 7. All other applicants must answer “Yes” or “No” for questions 6 and 7.
6.Have you agreed with anyone to sell the liquor of a manufacturer to the exclusion of another liquor manufacturer?
Yes |
No |
N/A |
If yes, provide details: |
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7.Do you or your immediate family members have any association with, or financial interest in, a liquor manufacturer, a liquor
importer, or the agent of a liquor manufacturer/importer? Yes |
No |
N/A |
If yes, provide details: |
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8.Have you entered into a Shareholder Agreement, Profit Sharing Agreement or other similar agreement with anyone not named in the
licence application? Yes |
No |
If yes, provide details (including percentage of interest shared with others): |
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9.Have you received any
or state? Yes |
No |
If yes, provide one of the following: |
(a)For driving infractions in Canada, provide a copy of your driver's abstract (driving record) for the past five (5) years. For information on how to acquire a copy of your BC driver's abstract, visit
(b)For driving infractions outside of Canada, provide a statutory declaration signed by a lawyer, Notary Public or Commissioner for Taking Affidavits that details the infraction, the date and the sentence or fine. (if not required on Question 3) For further information and to view a sample statutory declaration, refer to this LCLB web page: http://www.pssg.gov.bc.ca/lclb/
LLinBC/criminal_record_search.htm
10.Have you ever been charged with, discharged or convicted of, a criminal or drug/alcohol related offence under the laws of any
country or the laws or bylaws of any provincial, state or local government? Yes |
No |
If yes, provide the following: |
(i)a statutory declaration signed by a lawyer, Notary Public or Commissioner for Taking Affidavits providing details (i.e. date, disposition and sentence or fine, if applicable) of any charges, discharges, convictions or sentences inside or outside of Canada. For further information and to view a sample statutory declaration, refer to this LCLB web page: http://www.pssg.gov.bc.ca/ lclb/LLinBC/criminal_record_search.htm
(ii)a copy of your driver's abstract (driving record) for the past five (5) years. For information on how to acquire a copy of your BC driver's abstract please visit
If you have been issued a driver's licence outside Canada in the past five (5) years, provide a statutory declaration signed by a lawyer, Notary Public, or Commissioner for Taking Affidavits that states you have or have not received any
11.Attach a legible (colour preferred) photocopy of your driver's licence, passport or any other
12.Attach completed "Consent for Disclosure of Criminal Record Information" form (RCMP GRC3584)
DECLARATION AND AUTHORIZATION
My signature below indicates I understand and acknowledge that :
1.All the information given is true and complete to the best of my knowledge. Section 15(2) of the Liquor Control and Licensing Act states "A person applying for the issue, renewal, transfer or amendment of a licence who fails to disclose a material fact required by the form of application or makes a false or misleading statement in the form of application, commits an offence."
2.If the Liquor Control and Licensing Branch grants a licence as a result of this application, it will be granted only to the person(s) named in the application, or to a private corporation containing the principal shareholders and executive officers named in the application or to a public corporation or society containing the executive officers named in the application.
3.My signature authorizes the Royal Canadian Mounted Police to inquire into, and determine whether or not I may have a criminal record and report their findings to the Liquor Control and Licensing Branch. If necessary, I will provide my fingerprints to verify whether or not I may have a criminal record.
4.I understand I must provide a copy of my driving record for the past five (5) years if requested by the general manager.
Signature of Individual: |
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Date signed: |
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Freedom of Information and Protection of Privacy Act - the information for a liquor licence is collected under the authority of the Liquor Control and Licensing Act (RSBC 1996, c.267, s.15). The information is collected for the purpose of determining your eligibility for a liquor licence. Information may also be used by the Liquor Distribution Branch to determine your eligibility to purchase liquor. If you have any questions about the collection, use or disclosure of this information, please contact the Liquor Control and licensing Branch.
LCLB004 |
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Personal History Summary and Consent to Criminal Record Search |
Form Characteristics
| Fact Name | Details |
|---|---|
| Form Title | Personal History Summary and Consent to Criminal Record Search |
| Governing Laws | Liquor Control and Licensing Act (RSBC 1996, c.267, s.15) |
| Purpose | This form is used to provide personal history and consent for a criminal record check required for liquor licensing applications. |
| Contact Information | For questions, call the Liquor Control and Licensing Branch toll-free at: 1-866-209-2111. |
| Submission Instructions | Complete and submit the form with your application and other required documents to the Liquor Control and Licensing Branch Head Office. |
| Additional Documentation | Certain responses require additional documentation, like a statutory declaration or driver's abstract. |
Guidelines on Utilizing Criminal Report
Once you have the Criminal Report form ready, you need to fill it out completely before submitting it with your application and any required documents to the Liquor Control and Licensing Branch. Be sure to check all your answers and ensure the form is neat and legible. If any part of the form is unclear, you can reach out to the branch for assistance.
- Start by entering the location of the licensed establishment, liquor manufacturer, or liquor agency. Include the street address, city, province, and postal code.
- Provide the legal entity name and, if applicable, the licence or job number.
- Fill in your full name, including last, first, and middle names. Mark your gender by checking the appropriate box (M or F).
- Insert your birthdate in the year/month/day format, along with your birthplace and last name at birth.
- List any other last names you have used.
- Complete your current residence address and indicate whether you have used any other names, answering "Yes" or "No" appropriately.
- If you answered "Yes" regarding other names, provide the details of those names.
- Enter your business telephone number, personal telephone number, and business fax number with area codes.
- Provide your business email address.
- Answer question 1 about your residency in B.C. for the majority of the year, and provide details if the answer is "No."
- For question 2, indicate if you are a permanent resident in Canada for less than five years. If "Yes," attach the required documentation.
- Answer question 3 about living outside Canada or being a refugee. Attach a statutory declaration if applicable.
- Answer question 4 regarding your interest in any liquor licences and provide details if applicable.
- Indicate whether you hold a Rural Agency Store appointment from the Liquor Distribution Branch for question 5.
- For questions 6 and 7, answer whether you have agreements with other liquor manufacturers or any financial associations and provide details as needed.
- Detail any agreements you have entered into, as per question 8.
- For question 9, indicate if you've had any alcohol-related driving infractions in the past five years and provide the necessary documentation.
- Answer question 10 regarding any criminal or drug/alcohol-related offences, and attach the required statutory declaration if applicable.
- Attach a legible photocopy of your government-issued photo ID as outlined in question 11.
- Complete and attach the "Consent for Disclosure of Criminal Record Information" form as required.
- Finally, sign and date the declaration to confirm the truthfulness of the information provided.
What You Should Know About This Form
What is the purpose of the Criminal Report form?
The Criminal Report form is required to authorize a criminal record search for individuals applying for a liquor license in British Columbia. It collects personal information that helps determine the applicant's eligibility for obtaining or renewing a liquor license or related permits.
How should I complete the Criminal Report form?
The form can be completed electronically or by hand. If filling it out by hand, use dark ink and print clearly. Ensure all information is accurate and complete, as inaccuracies may cause delays in processing your application.
Where do I submit the completed form?
After completing the Criminal Report form, submit it along with your application and any other required documents to the Liquor Control and Licensing Branch Head Office. Ensure that all documents are submitted in one package to streamline the review process.
What should I do if I have questions while filling out the form?
If you encounter any questions during the completion of the Criminal Report form, you can call thebranch toll-free at 1-866-209-2111 for assistance. A representative can guide you through any confusing sections.
Who needs to complete the Criminal Report Form?
All individuals applying for a liquor license or related permits must complete the Criminal Report form. This includes sole proprietors, partners, and any individuals with a controlling interest in a business seeking a liquor license.
What documentation do I need to provide with the form?
In addition to completing the Criminal Report form, applicants must provide supporting documents such as identification (driver’s license or passport) and a statutory declaration if applicable. Details about any past infractions or criminal charges must also be included.
What happens if I do not disclose my criminal history?
Failure to disclose a criminal history as required by the form can lead to serious consequences. Section 15(2) of the Liquor Control and Licensing Act states that failing to disclose material facts or making false statements can result in committing an offence and may jeopardize your application.
How does the Royal Canadian Mounted Police (RCMP) get involved?
Your signature on the form authorizes the RCMP to conduct an inquiry into whether you may have a criminal record. They will report their findings back to the Liquor Control and Licensing Branch, which plays a crucial role in your application process.
Can I apply for a liquor license if I have a criminal record?
Having a criminal record does not automatically disqualify you from obtaining a liquor license. However, you must provide detailed information about any offenses and comply with all disclosure requirements. Each case is considered on its individual merits during the review process.
Common mistakes
When filling out the Criminal Report form, many individuals make common mistakes that can delay or derail their application. One prevalent error involves providing inaccurate personal details. It's crucial to ensure that names, birthdates, and other identifying information are correct. Minor typos or incorrect birth dates can lead to confusion and may require additional clarification, slowing down the process.
Another frequent mistake is neglecting to check for the correct selection in response to the gender question. An oversight here might seem trivial, but it could raise questions about identity verification later in the application process. Paying careful attention to all fields, including gender, is essential for accuracy. Furthermore, failing to indicate all previous names used can create complications. If individuals have undergone name changes, the omission may necessitate further documentation.
Completing the residency question incorrectly also poses a risk. Applicants must clearly state whether they reside in British Columbia for more than six months of the year. If the answer is “no,” providing details about residence is not optional but required. Missing this important detail can lead to delays in processing.
Asking if previous alcohol-related infractions were disclosed is equally important. Check this thoroughly; any past infractions must be reported accurately and completely, as this transparency fosters trust. Failure to report or misreport such details could have serious repercussions on the application.
Providing incomplete supporting documentation is another mistake people often make. For example, someone who has been a permanent resident must attach necessary documents, such as the “Record of Landing,” without exception. The necessary accompanying statutory declaration must also be part of the submission. Omitting these documents is a common oversight that can lead to application rejection.
Respondents also frequently misunderstand the statutory declaration requirement. It’s not enough to say “yes” or “no” to past charges or infractions—detailed explanations and supporting documents must be provided as stated in the instructions. Not fully understanding this requirement risks the application being considered incomplete.
Neglecting to include specific information regarding previous liquor licenses or current agency store appointments can also derail an application. If any previous license affiliation exists, it should be disclosed completely. This includes details on location, name, type, and current status. The failure to provide such particulars can be interpreted as a lack of transparency.
Using unclear handwriting or poor quality printing is another significant issue. For those filling out the form by hand, printing must be legible and in clear, dark ink. Illegible forms may lead processing staff to misinterpret answers, potentially causing significant delays.
Lastly, applicants must remember to sign and date the form. It's surprising how many forget this last crucial step. The declaration signifies understanding and acknowledgment of the information provided, and without a signature, the submission cannot proceed.
Documents used along the form
When applying for a liquor license or engaging with the Liquor Control and Licensing Branch, several important forms and documents may accompany the Criminal Report Form. Each document serves a specific purpose to ensure compliance with the law and to assess eligibility properly. Below is a list of such documents, along with brief descriptions of their roles in the application process.
- Consent for Disclosure of Criminal Record Information (RCMP GRC3584): This form grants permission for the RCMP to access an individual's criminal record. It is essential for thorough background checks.
- Statutory Declaration: This legal document may be required to affirm specific facts, such as past criminal charges or other relevant details. It must be signed by a lawyer, Notary Public, or Commissioner for Taking Affidavits.
- Driver's Abstract: This is a record of a person's driving history, including any infractions. It may be required for applicants with prior alcohol-related driving offences.
- Residency Documentation: Proof of residency may be needed, particularly in cases where the applicant resides outside of Canada or has moved recently.
- Business Registration Documents: Documentation that shows the legal status of the business entity applying for the license, ensuring that personal and corporate identities are clearly defined.
- Proof of Identification: A clear photocopy of a valid government-issued photo ID is often necessary to verify identity and eligibility.
- Certificate of Incorporation: For applicants representing corporations, this document proves the legal establishment of the business as a corporation.
- Financial Statements: Depending on the type of license being applied for, evidence of financial stability may be requested to ensure the applicant can maintain proper operations.
- Court Documents: In cases of past legal issues, documents related to any court proceedings might need to be submitted for full transparency.
- Authorization for Third-Party Representatives: If an applicant is using someone else to represent them in matters regarding the liquor license, a signed authorization form is necessary.
These documents collectively support a comprehensive examination of the applicant’s qualifications and compliance with regulatory requirements. Ensuring that all necessary paperwork is in order can streamline the application process and foster a more efficient review of your eligibility for obtaining a liquor license.
Similar forms
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Criminal Background Check Form: This form requires individuals to provide personal information, including past criminal activities. Like the Criminal Report form, it seeks consent for a thorough background check to ensure compliance with regulations.
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Application for Employment with Criminal History Disclosure: Applicants must disclose criminal history on this document. Similar to the Criminal Report form, it aims to evaluate an applicant's background for potential risks in employment.
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Consent for Disclosure of Criminal Record Information (RCMP GRC3584): This consent form authorizes police to release criminal record information. Much like the Criminal Report form, it focuses on obtaining necessary permissions to access confidential data.
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Liquor License Application Form: This form assesses the eligibility of applicants in the liquor industry. It parallels the Criminal Report form in gathering personal and legal history to determine suitability for licensing.
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Volunteer Background Check Application: Volunteers often complete a form to undergo a background check. Similar to the Criminal Report form, it intends to protect vulnerable populations by revealing any concerning history that may affect their roles.
Dos and Don'ts
When filling out the Criminal Report form, certain actions can streamline the process, while others can create unnecessary complications. Below is a guide on what to do and what to avoid.
- Do complete the form accurately and truthfully. Ensure all information reflects your current status and history.
- Do print clearly if filling out the form by hand, using dark ink for legibility.
- Do check for any required documents to attach, such as your driver's abstract or statutory declarations.
- Do contact the branch toll-free if you have any questions about the form.
- Do sign the form to authorize the necessary inquiries regarding your criminal record.
- Don't leave any sections blank. Incomplete forms can lead to delays or rejections.
- Don't provide misleading or false information. This can result in legal consequences and damage your application.
Misconceptions
When it comes to the Criminal Report form, it's easy to harbor misconceptions. Understanding the truth behind these myths can help you navigate the application process with confidence. Here are some common misconceptions:
- Everyone Needs a Criminal Record: Many believe that a criminal record check is required for all applicants, regardless of their background. In reality, only specific applicants, such as those involved in liquor-related businesses, may need to undergo this check. Depending on your role, you might not need to worry about it at all.
- Completing the Form is Complicated: Some feel intimidated by the form, thinking it requires complicated legal knowledge. However, most people can fill it out with basic personal information along with some straightforward questions about their backgrounds. Just read each question carefully, and don’t hesitate to reach out for assistance if needed.
- Submitting the Form Guarantees Approval: Another myth is that turning in the Criminal Report form ensures a liquor license will be granted. Although completing the form is a necessary step, approval depends on various criteria, including not only the provided information but also checks conducted by the responsible authorities.
- Past Offenses Will Automatically Disqualify Me: Many fear that any past criminal offense will lead to disqualification. While previous offenses may be relevant, they don't necessarily make you ineligible. The application process also considers the nature of the offense, its recency, and the applicant's current standing.
By debunking these misconceptions, you can approach the application process with a clearer mindset. Make sure you understand the requirements and take the time to complete the form accurately. Good luck!
Key takeaways
When filling out and using the Criminal Report form, careful attention to each section is crucial for a successful application. Here are some essential takeaways to consider:
- Accurate Information: Ensure that all personal details, including names, addresses, and contact information, are accurate and match your legal documents.
- Clear Printing: If completing the form by hand, print clearly in dark ink. If possible, fill out the form digitally before printing to maintain legibility.
- Attachments Are Necessary: Be prepared to attach all required documents, such as a driver's abstract and any relevant statutory declarations, as specified in the instructions.
- Respond to All Questions: Answer every question truthfully. If you need to provide additional information beyond the provided space, use an attached sheet and refer to it accordingly.
- Understand the Legal Implications: Acknowledge that providing false information can result in serious legal consequences, including potential rejection of your application.
- Keep Copies for Your Records: Save copies of your completed form and all accompanying documents for your personal records before submission.
These key points will help ensure a smoother process as you navigate the requirements of the Criminal Report form.
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