Integrity Questionnaire

Note: Please do not complete the questionnaire in advance. The Integrity Questionnaire is posted online for information purposes only. You will be provided with a copy of the questionnaire to complete at a later stage in the hiring process.

PDF (796 Kb) [help with PDF files]

The information collected in this form is personal.

PROTECTED B (once completed)

The Canada Border Services Agency (CBSA) is responsible for providing integrated border services that support national security and public safety priorities and facilitate the free flow of persons and goods into Canada.

To fulfill this mission, employees of the CBSA must conduct themselves with integrity, respect and professionalism. It is imperative, therefore, that the CBSA carefully assess the integrity of new applicants and current employees. To facilitate such an assessment, the CBSA has developed the following Integrity Questionnaire.

• Applicant Surname:
• Applicant Given Name(s):
• Mailing Address (Street address, city, province, postal code):
• Telephone No. 1:
• Telephone No. 2:
• E-Mail Address:

Before writing answers to the questions contained in this Integrity Questionnaire, Applicants are advised to:

• carefully read the information and notices;
• read, initial and sign the Declaration, Acknowledgment, and Consent;
• follow the instructions listed.

NOTICE REGARDING THE COLLECTION AND USE OF PERSONAL INFORMATION

The information you provide in this document is collected under the authority of the Financial Administration Act (FAA) sections 7(1), 11.1(1) and 12(1)(e), Sections 5 and 11 of the Canada Border Services Agency Act, Section 31 of the Public Service Employment Act and the Policy on Government Security. It is collected for the purposes of providing a security screening assessment, for the reliability status, security clearance or site access of individuals working or applying to work through appointment, assignment or contract at the Canada Border Services Agency. The information may be disclosed to the Canadian Security Intelligence Service (CSIS) and the Royal Canadian Mounted Police (RCMP) as service providers in accordance with the Policy on Government Security. The security screening status may be shared within the Canada Border Services Agency to update individual’s personnel file. Information may also be shared with entities outside the Federal Government, including credit bureaus for the purposes of conducting reliability personnel security screening checks, conducting database checks, audit, statistical, periodic data matching and to assess an individual’s loyalty and reliability as it relates to loyalty. The information may be used by accredited domestic law enforcement agencies in the administration or enforcement of the law and in the detection, prevention or suppression of a crime.

The information provided in the Integrity Questionnaire will be retained by the CBSA for a minimum of two years and may be used to determine your suitability and reliability, and to conduct a security assessment for any other position within the CBSA to which you may apply. This may result in your disqualification from that other hiring process.

Individuals have the right of access to, the protection and correction of their personal information under the Privacy Act. The information collected is described under the Personnel Security Screening Program Personal Information Bank CBSA PPU 1108 which is detailed at www.infosource.gc.ca.

“I, the undersigned, do consent to the disclosure of the preceding information including my photograph for its subsequent verification and/or use in an investigation for the purpose of providing a security screening assessment. By consenting to the above, I acknowledge that the verification and/or use in an investigation of the preceding information may also occur when the reliability status, security clearance or site access are updated or otherwise reviewed for cause under the Policy on Government Security. My consent will remain valid until such time as any such reliability status, security clearance or site access clearance is no longer a requirement for my continued employment with the CBSA, or any successor thereto, my employment is terminated, I am deployed to a position with another employer within the Government of Canada, or I revoke my consent, in writing, to the Director General, Security and Professional Standards of the Agency.”

NOTICE REGARDING THE INTEGRITY QUESTIONNAIRE

Your decision to complete the Integrity Questionnaire must be voluntary, based on your desire to pursue a career with the CBSA.

You may withdraw from the application process at any time. You may refuse to provide answers to any or all of the questions contained in the Integrity Questionnaire. Such a refusal may result in your disqualification from the recruitment process.

You should answer the questions contained in the Integrity Questionnaire accurately, completely, thoroughly, and honestly to the best of your knowledge and belief. An incomplete Integrity Questionnaire may result in your disqualification from the recruitment process.

You are not required to provide any information in the Integrity Questionnaire that relates to a conviction for which a pardon has been received or a conviction that was processed pursuant to the Young Offenders Act (R.S.C. 1985, c. Y-1, now repealed) or the Youth Criminal Justice Act (S.C., 2002, c.1).

Should there be a change in circumstances, after your submission of the Integrity Questionnaire, which would require that you amend any of the responses made in the Integrity Questionnaire for it to be complete and accurate, you should contact the Recruitment Officer.

Deceit, dishonesty, or non-disclosure in any part of the application process is likely to result in your disqualification from the recruitment process and/or any future employment with the CBSA.

If you are currently employed by, or working for the CBSA, the information provided in the Integrity Questionnaire may be used to determine your suitability and reliability, and for security screening purposes. This may result in your disqualification from the employment process in question. This may also lead to, where applicable, the imposition of discipline, the revocation of an existing reliability status/security screening level, and/or possible dismissal from current employment.

NOTICE REGARDING MISCONDUCT, CRIMINAL OFFENCES AND RISK TO THE SAFETY OF OTHERS

The information you provide during the recruitment process is collected by the CBSA for the purposes of an employment application, and security screening. All answers which reveal criminal activity may be disclosed to the RCMP and CSIS as part of the security screening process.

If you admit to having committed one or a number of criminal offence(s), for which a pardon was not obtained, on the Integrity Questionnaire or during the Integrity Interview, be advised that the information may be disclosed to entities with lawful authority to collect such information (e.g. police of jurisdiction or child protection agency).

If, in light of the information provided throughout the screening process, you are deemed to pose a threat to others, be advised that the information may be disclosed to entities with lawful authority to collect such information (e.g. police of jurisdiction).

You are also advised that such disclosures could lead to incident reports being entered into police databases, which could impact future employment or volunteering opportunities, or other activities that require security screening (e.g. employment with schools, banks, etc.).

Such disclosures could also lead to an investigation, arrest, charge(s), criminal prosecution, conviction, and, ultimately, imposition of a sentence.

DECLARATION, ACKNOWLEDGMENT, AND CONSENT

Should you have any questions concerning what you have read in the preceding pages, please contact your Recruitment Officer to clarify before proceeding any further.

Please ensure that you initial each of the following statements in the space provided:

	Applicant Initials
I, the undersigned, have read and understand the information and notices of this Integrity Questionnaire.
I complete this Integrity Questionnaire voluntarily, based on my desire to pursue a career with the CBSA.
I declare that I will provide, in this Integrity Questionnaire, information that is up-to-date, accurate, complete and honest, to the best of my knowledge and belief.
I understand that there is a possibility that I may amend my answer(s) to any question (s) in the Integrity Questionnaire by contacting the Recruitment Officer.
I understand that I do not have to include any information in this Integrity Questionnaire that relates to a conviction for which a pardon has been received, or a conviction that was processed pursuant to the Young Offender's Act or the Youth Criminal Justice Act.
I understand that the information provided in this Integrity Questionnaire may affect my possibilities for any other employment with, or at, the CBSA within the next two (2) years, and/or, where applicable, may affect my current employment with, or work at, the CBSA.
I understand that if I admit to having committed one or a number of criminal offence(s), in this Integrity Questionnaire or during the Integrity Interview, actions could be taken which could lead, ultimately, to the imposition of a sentence.
I consent to my personal information being collected, used, and disclosed for the purposes identified of this Integrity Questionnaire.
I consent to my personal information being used for security screening pursuant to the Treasury Board Policy on Government Security (www.tbs-sct.gc.ca).

• Name of Applicant (print):
• Signature of Applicant:
• Date:

Please read and follow these instructions for Completion of the Integrity Questionnaire carefully

General:

1. Once completed by the Applicant and received by the CBSA, this Questionnaire will be safeguarded and handled by the CBSA at the level of “Protected B”.

2. Considering the personal and sensitive nature of the information to be provided, you should complete the Questionnaire in private, on your own, and without the assistance of a third party (e.g. family member(s) or friend(s)).

3. The Questionnaire must be completed clearly and legibly. It can be filled out on-line or, if handwritten, it must be in black ink. Illegible forms will be returned for clarification and will potentially slow down the recruitment process.

4. Answer the questions accurately, completely, and thoroughly by providing information that is up to date and honest to the best of your knowledge and belief. An incomplete Integrity Questionnaire may result in your disqualification from the recruitment process.

5. Once the completed Questionnaire is received by the Recruitment Officer, it will be reviewed. The Recruitment Office and/or the CBSA Personnel Security Screening Office may contact you to seek additional information or clarify your answers to the questions contained in the Integrity Questionnaire.

6. You may amend your answer(s) to any question(s) contained in the Integrity Questionnaire, by contacting the Recruitment Office.

Detailed Instructions:

7. Complete this Integrity Questionnaire only if you are responding of your own free will and understand that you may stop the process at any time.

8. All applicants must complete Sections A to L (questions 1 to 57). Follow instructions at the start of each section, and read each question carefully.

9. If the space allotted for any question is insufficient, use the back of the corresponding sheet, and identify the answer by referring to the section and number.

10. In your answers provide details stating whether the incidents or situations occurred in Canada or in another country.

11. You are under no obligation to disclose any information regarding a crime where you were a victim.

12. You are not obligated to include any information that relates to a conviction for which a pardon has been received, or a conviction that was processed by way of the Young Offenders Act or Youth Criminal Justice Act.

13. Provide detailed answers for each question. Wherever possible, provide circumstances, locations, dates (including month and year), why and how the event/incident took place, as applicable.

14. You may contact the Recruitment Officer to ask questions or for clarifications before returning your Questionnaire.

15. Review your answers, sign and date the Final Declaration, Acknowledgment and Consent on the last page.

SECTION A - Driving History

1. Have you ever applied for a driver’s licence and been denied or has your driver’s licence ever been restricted, suspended or revoked for any reason?

• Yes
• No
• If yes, explain:

2. Have you ever been refused automobile insurance or had it cancelled or suspended?

• Yes
• No
• If yes, explain:

3. Do you have any outstanding motor vehicle/driving violation(s) and/or unpaid traffic tickets, including parking tickets?

• Yes
• No
• If yes, explain:

SECTION B – Alcohol/Drugs

4. How much alcohol do you consume per week on average?

• Type of Alcohol
• Amount and Frequency (weekly basis)
• Circumstances of Use

5. Have you ever purchased alcohol with a counterfeit ID, purchased alcohol for minors or given alcohol to minors?

• Yes
• No
• If yes, explain:

6. Have you ever operated a motorized vehicle or vessel while under the influence of alcohol and/or illegal drugs?

• Yes
• No
• If yes, explain:

7. Have you ever been treated or sought treatment or counselling for a substance (drugs, alcohol) abuse problem?

• Yes
• No
• If yes, explain:

8. Have you ever used any illegal/illicit drugs that were not prescribed by a physician?

• Yes
• No
• If yes, provide the requested information for each drug and explain the circumstances of use:
  • Drug
    • Acid/LSD
    • Catha Edulis (Khat)
    • Cocaine
    • Crack
    • Crystal Meth
    • Date Rape (DMX, GHB, Rohyphonol)
    • Ecstasy
    • Hash/Hash Oil
    • Heroin
    • Inhalants (glue, gasoline, paint)
    • Ketamine
    • Marijuana
    • Mescaline
    • Methamphetamine
    • Mushrooms
    • PCP
    • Steroids
    • Other (specify):
  • Method and Frequency of Use
  • Approximate dates of use (first time, last time)
  • Circumstances/Motives for use
  • Means to obtain drugs
  • Financial outlay (How much do/did you spend on drugs on a monthly basis?)

9. Have you or your spouse/common law partner or cohabiter ever sold any illegal or prescription/non-prescription drugs?

• Yes
• No
• If yes, explain:

10. Have you or your spouse/common law partner or cohabiter ever grown, produced or harvested illegal drugs and/or, imported, exported or mailed any illegal or prescription drugs?

• Yes
• No
• If yes, explain:

11. Have you ever misused or been dependent upon prescription or non-prescription drugs?

• Yes
• No
• If yes, provide information for each drug and explain the circumstances of use:If yes, provide the requested information for each drug and explain the circumstances of use:
  • Drug
    • Antihistamines
    • Dilaudid
    • Methadone
    • Oxycodine
    • Oxycontine
    • Percocet
    • Percoden
    • Prozac
    • Ritalin
    • Valium
    • Zanax
    • Other (specify):
  • Method and Frequency of Use
  • Approximate dates of use (first time, last time)
  • Circumstances/Motives for use
  • Financial outlay (How much do/did you spend on drugs on a monthly basis?)

12. Have you ever been charged, convicted of an offence for which a pardon was not received or granted a discharge for any offence involving trafficking, importing and/or exporting drugs or controlled substances?

• Yes
• No
• If yes, explain:

13. Do you knowingly associate with anyone who uses illegal drugs (family, friends, etc)?

• Yes
• No
• If yes, explain:

SECTION C - Gambling

NOTE: Provide any requested currency amounts in Canadian dollars.

14. Do you or your spouse/common law partner or cohabiter gamble (including lottery, casinos, online gaming, scratch tickets, etc)?

• Yes
• No
• If yes, how often and explain:

15. How much money have you or your spouse/common law partner or cohabiter spent, wagered, lost or won in the last year as a result of gambling to the best of your knowledge?

• Amount
• Spent $
• Wagered $
• Lost
• Won
• Owe

* Remember to provide amounts in Canadian dollars.

16. Do you or your spouse/common law partner or cohabiter presently owe any gambling debts?

• Yes
• No
• If yes, specify who owes the debts.
  • Amount
  • Spent $
  • Wagered $
  • Lost
  • Won
  • Owe

* Remember to provide amounts in Canadian dollars.

SECTION D - Security

17. Have you ever provided fraudulent or misleading information regarding yourself or other people or persons seeking entry into Canada?

• Yes
• No
• If yes, explain:

18. Have you ever possessed or do you currently possess false/fraudulent identification?

• Yes
• No
• If yes, explain:

19. Do you possess multiple citizenships or were you ever a citizen of another country other than Canada? If yes, identify type of citizenship and country below:

• Multiple
• Former
• Country

20. Do you or your spouse/common law partner or cohabiter hold or have previously held any loyalties to organizations, or persons, or beliefs, which could supersede or take precedence over your loyalty to Canada?

• Yes
• No
• If yes, explain (name and type of organization, etc.):

21. Do you have any foreign property, business connections, or financial interests?

• Yes
• No
• If yes, explain:

22. Are you susceptible to or have you ever been subjected to blackmail/attempted blackmail or coercion?

• Yes
• No
• If yes, explain:

SECTION E - Use of Force

23. Have you ever committed an act of domestic abuse including the use of, or the threat of use of violence against your spouse, partner, parents, children, siblings, pets, etc.?

• Yes
• No
• If yes, explain:

24. Have you ever been charged, convicted of an offence for which a pardon was not received or granted a discharge for any offence involving the misuse, possession or storage of a firearm or other weapon?

• Yes
• No
• If yes, explain:

25. Have you ever pointed a weapon such as a knife or a firearm whether loaded or not at yourself or another person?

• Yes
• No
• If yes, explain:

26. Have you ever been accused, investigated, charged or convicted of an offence for which a pardon was not received related to the excessive use of force

• Yes
• No
• If yes, explain:

27. Have you ever been refused a firearms permit or had a permit revoked?

• Yes
• No
• If yes, explain:

SECTION F - Unlawful Sexual Activity

28. Have you ever travelled outside of Canada for the purpose of engaging in sexual activity with a person under the age of 18 (sexual tourism)?

• Yes
• No
• If yes, explain:

29. Have you ever solicited the services of a prostitute>

• Yes
• No
• If yes, explain:

30. Have you ever engaged in sexual activities with someone who was under age 16 or have you ever had sex with someone against his/her will or without his/her consent (includes persons unable to give permission due to a medical condition, mental health issue, alcohol, drugs, or other reasons)?

• Yes
• No
• If yes, explain:

31. Have you ever viewed, possessed, stored, produced or downloaded images of child pornography, bestiality and/or other prohibited subject matter on the Internet?

• Yes
• No
• If yes, explain:

SECTION G - Involvement with Law Enforcement

32. Have you ever had a court order issued against you (includes search warrant, arrest warrant, peace bond, restraining order(s), protection order or restitution order)?

• Yes
• No
• If yes, explain:

33. Have you ever done anything for which you could have been arrested but were not?

• Yes
• No
• If yes, explain:

34. Have you ever been wanted, investigated, arrested, charged and/or convicted of any criminal offence for which a pardon was not received in Canada or in a foreign country?

• Yes
• No
• If yes, explain:

35. Have you or your spouse/common law partner or cohabiter ever associated in any way with organized crime or with a terrorist group?

• Yes
• No
• If yes, explain:

36. Have you ever been questioned or investigated by the CBSA (Immigration, Customs, Canada Food Inspection Agency), any police agency or any Government Department/Agency as a complainant, a witness or a suspect?

• Yes
• No
• If yes, explain:

37. Have you ever stolen anything (includes shoplifting)?

• Yes
• No
• If yes, explain:

38. Have you ever falsified an insurance claim (e.g. motor vehicle injury claim, worker’s compensation claim, theft claim, property loss or damage, etc.)?

• Yes
• No
• If yes, explain:

39. Have you or your spouse/common law partner or cohabiter ever illegally imported or exported goods of any kind from or into any country including Canada?

• Yes
• No
• If yes, explain:

40. Have you or your spouse/common law partner or cohabiter ever been put on probation or court supervision?

• Yes
• No
• If yes, explain:

SECTION H - Computers and Technology

41. Have you ever used a phone, a computer or the Internet for illegal or nuisance purposes (i.e. Child Pornography, Hacking, Spamming, Harassment)?

• Yes
• No
• If yes, explain:

42. Have you ever hacked and/or attempted to gain unauthorized access into any computer system (i.e. business, private, law enforcement, Canadian or foreign government systems)?

• Yes
• No
• If yes, explain:

43. Have you or your spouse/common law partner or cohabiter ever committed credit card/bank card fraud, identity theft, or any other form of false pretense over the Internet?

• Yes
• No
• If yes, explain:

SECTION I - Employment

44. Did you intentionally omit any prior places of employment from your employment application (within the past ten years or from the age of 16)?

• Yes
• No
• If yes, explain:

45. Have you ever been an employee of and/or have you ever been refused employment with the Government of Canada, the military, a police service, and/or an intelligence service (includes the CBSA, the Department of National Defence, the RCMP and the Canadian Security Intelligence Service)?

• Yes
• No
• If yes, explain:

46. Have you ever been employed and deliberately not disclosed your income for tax purposes?

• Yes
• No
• If yes, explain:

47. Have you ever received any type of oral or written reprimand or any other type of discipline (suspension, time off without pay, etc.)?

• Yes
• No
• If yes, explain:

48. Have you ever had your employment terminated with or without cause?

• Yes
• No
• If yes, explain:

49. Have you ever received a verbal or written warning regarding absenteeism?

• Yes
• No
• If yes, explain:

SECTION J - Lifestyle

50. Have there been any major changes in your lifestyle during the past five (5) years, such as divorce and/or separation, a lottery win, a financial loss, bankruptcy, an illness, a death, job loss, etc.?

• Yes
• No
• If yes, explain:

SECTION K – Affiliations

51. Have you, your spouse/common law partner or cohabiter or any of your family members ever been employed by a government or an organization (Canadian or foreign) in a security-related capacity?

• Yes
• No
• If yes, explain and provide details on the group/organization:

52. Have you, your spouse/common law partner or cohabiter or any of your family members ever held a position of authority in any government, or judiciary or a political party outside of Canada?

• Yes
• No
• If yes, explain and provide details on the group/organization and your relationship with that family member:

53. Have you, your spouse/common law partner or cohabiter or any of your family members ever been in a military, militia or civil defence unit or the police?

• Yes
• No
• If yes, explain and provide details on the group/organization and your relationship with that family member:

54. Have you, your spouse/common law partner or cohabiter or any of your family members ever been a member or associated with any group or organization which has engaged in or advocated violence, hate propaganda, or which has been associated with criminal activity at any time?

• Yes
• No
• If yes, explain and provide details on the group/organization:

55. Have you or your spouse/common law partner or cohabiter ever sponsored anyone from another country to come to Canada?

• Yes
• No
• If yes
• • Who have you sponsored? Please provide details regarding the principal applicant that you are currently or have sponsored in the past, including their country of origin as well as the country they are being or were sponsored from, the date of sponsorship, their full name(s) and date(s) of birth as well as the current address.
  • What form of sponsorship did you use (ie. family, spouse or common-law, employment, etc.)?
  • Indicate the nature of your relationship to the principal applicant?
  • Indicate the principal applicant’s current status in Canada?
  • Indicate if you are aware of the principal applicant’s activities and the relevant details of those activities, including any criminal activity, any associations with any group or organizations which have engaged in or advocated violence, or which have been associated with criminal activity at any time along with the name and type of activity / organization.

(If more space is required, please provide the requested information in the same format on another sheet)

SECTION L – Immediate Relatives/Spousal/Partner Information

56. Please provide the requested information on current and previous spouses/common-law partner/partners:

• Current Spouse/Common Law Partner/Partner
  • Marital Status/Common-Law Partner/Partner:
  • Current Relationship Status:
  • Full Name of Current Spouse/Common Law Partner/Partner:
  • Maiden Name (if applicable): Present Citizenship of current Spouse/Common Law Partner/Partner:
  • Date of marriage/common-law partnership:
  • City, province or state, and country of marriage/common-law partnership:
  • City, province or state, and country of birth:
  • Date of birth:
  • Present address:
  • Name and address of employer (job title):
  • If separated, widowed or divorced, specify date:
• Full Name of Previous Spouse/Common Law Partner/Partner:
  • Maiden Name (if applicable):
  • Present Citizenship of former Spouse/Common Law Partner/Partner:
  • City, province or state, and country of birth (if known):
  • Date of birth: Date of marriage/common-law partnership:
  • Date of divorce/separation/deceased:
  • City, province or state, and country of marriage/common-law parter:
  • City, province or state, and country of divorce:

57. Please provide the requested information on relatives including: mother, father, brothers, sister, all children 18 years and over, include half or step relatives, your current spouse’s or common law partners father and mother including half or step relatives and any cohabiter(s):

• Relatives (including those living outside Canada) and Cohabiter(s)
  • Full name (surname and all given names, including maiden name:
  • Relationship:
  • City, province or state, and country of birth:
  • Date of birth:
  • Present address:
  • Name and address of employer (job title):
  • Date of death (if applicable):

(If more space is required, please provide the requested information in the same format on another sheet)

This Integrity Questionnaire is not complete until you have read, understood, signed, and dated the Final Declaration, Acknowledgment, and Consent. If sent to the CBSA Recruitment Office without your printed name, signature, and date on this page, this Integrity Questionnaire will be returned to you, if you provide a forwarding address. If no forwarding address is provided, your application will be destroyed.

Note: This will delay your application process.

Final Declaration, Acknowledgment, and Consent of:
Name of Applicant (print)

I, the undersigned, hereby declare that the information I have provided in this Integrity Questionnaire (referred to on this page as the preceding information) is up to date, accurate, complete, and honest, to the best of my knowledge and belief.

I acknowledge that the preceding information may be used in accordance with the notices of this Integrity Questionnaire and I consent to its subsequent verification and/or use for the purposes of evaluating my suitability and reliability, and the security screening assessment.

I further acknowledge that the verification and/or use of the preceding information may also occur when my reliability status, security clearance or site access - if issued - are updated or otherwise reviewed for cause under the Policy on Government Security.

I acknowledge that, if I have indicated in this Integrity Questionnaire that I have committed a criminal offence or that I pose a risk to the safety of others, I am to provide this information to the CBSA.

If I return this completed Integrity Questionnaire containing criminal admissions, I acknowledge that the CBSA may use and/or disclose such information for a law enforcement or public safety purpose as described under the "Notice Regarding Misconduct, Criminal Offences and Risk to the Safety of Others" of this Integrity Questionnaire.

By my signature below, I declare that I have read and understand how the preceding information will be managed and I hereby consent to the use and disclosure of my personal information as described herein the Integrity Questionnaire.

• Signature of Applicant
• Date