Integrity and Lifestyle Questionnaire - Recruit

AD-3303

PERSONAL INFORMATION:
Surname: Given Name(s):
Date of Birth: Date of submission:
(yy-mmm-dd) (yy-mmm-dd)

Thank you for your application to Surrey Police Service (SPS). We greatly value the knowledge, skills, and
experience that a potential recruit can bring to SPS.
As you already understand, honesty, lifestyle, and integrity are important qualities for police officers and so it is
important for SPS to examine all applicants’ suitability. Information supplied in this document will be considered
in the context of the competition for employment for the position applied for and will be held in confidence
under those circumstances.
The Recruiting team will be doing a thorough background investigation, which will involve speaking to references
you provide and possibly other people you know who can verify or provide additional information. It is important
that you provide thorough, honest, and complete answers to all the questions in the ILQ and at every stage of
the process, regardless of the nature of the incident. This will afford you the best opportunity to be successful
at all stages in the recruiting process.

Collection, Use, Access, Retention, and Disclosure of your Personal Information

The information you provide during the application process is collected by SPS for the purpose of an employment
application. Personal information collected for the purposes of the employment process and determining
suitability for employment with SPS is collected under section 26(c) of the Freedom of Information and
Protection of Privacy Act (FOIPPA). It is retained and protected under section 30 of the FOIPPA, which requires
a public body to protect personal information in its custody or under its control by making reasonable security
arrangements against risks of unauthorized access, collection, use, disclosure, or disposal.
Your personal information will be stored securely within Surrey Police Service Recruiting Section, and access to
records in recruiting databases is restricted to those involved in the recruiting process. Your personal information
will not be disclosed except under section 33 of the FOIPPA. The Recruiting Section will retain your personal
information for a minimum of 5 years.
If you have any questions or concerns about the collection of your personal information, please contact the
Surrey Police Service careers@surreypolice.ca
If an applicant admits to having committed a serious and undetected criminal offence or is deemed to pose a
serious risk to the safety of others, SPS may use or disclose specific information for a law enforcement or public
safety purpose. While cases of such use and disclosure outside of the Recruiting Process are rare and exceptional,
SPS strongly discourages an applicant from completing this form if you believe this notice applies to you.

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 1

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
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Examples of serious criminal offences include, but are not limited to:
• Murder
• Impaired Driving
• Sexual assault
• Crimes relating to domestic violence
• Child pornography (includes accessing, possession, distribution, or production)
• Offences contrary to the Controlled Drugs and Substances Act
• Robbery
• Treason or high treason
• Forcible confinement
• Crime committed with a facial covering and/or a weapon
• Any crime involving children (includes physical or sexual abuse)
DECLARATION, ACKNOWLEDGEMENT, AND CONSENT
Collection and Retention of Information:
☐ I consent to the collection and retention of my personal information (including applications, attachments,
and draft applications) within Surrey Police Service Recruiting Section, and which will be collected and retained
by Surrey Police Service in accordance with applicable laws.
Use of Information:
☐ I consent to my personal information being used and disclosed by Surrey Police Service for recruitment and
hiring purposes, including to conduct reference checks and verify the accuracy and completeness of my personal
information. I further consent to Surrey Police Service sharing this personal information with any third party
assisting with the recruitment and hiring processes.
☐ I consent to Surrey Police Service using my personal information to consider me for any positions with Surrey
Police Service in addition to those for which I have applied.
Truth, Completeness and Accuracy of Personal Information:
☐ I confirm that, to the best of my ability, I have provided personal information that is truthful, complete, and
accurate.
☐ I am aware that any false, incorrect, or misleading information will render my application void and may cause
my profile to be deleted.
☐ I consent to Surrey Police Service verifying the truth, completeness, and accuracy of my personal information
as part of the recruitment and hiring process.
☐ I acknowledge that the submission of my personal information or applying for any positions does require
Surrey Police Service to consider me for any position.

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 2

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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To apply for a position with SPS you must read the following Terms of Agreement and select the “I
agree to the Terms of Agreement” checkbox, type your name (this will be your legal signature), and
date before submitting your documentation.
☐ I have read and understood the Surrey Police Service Terms and Conditions
☐ I agree with the Surrey Police Service Terms and Conditions

Please follow the instructions below carefully. Incomplete questionnaires will not be reviewed.
1. All questions must be answered. Incomplete questionnaires will not be processed. If a question is not
applicable use “N/A” in the appropriate space. If an entire section is not applicable, one “N/A” in the
first space is sufficient.
2. Date format should follow yy-mmm-dd (10-Jan-31).
3. When answering questions with a yes/no box, please check the box you wish to select. We are aware
that some questions are duplicates of questions asked of you in the application form.
4. Unless otherwise instructed, list items in chronological order beginning with the most recent. Leave no
gaps in dates.
5. If extra space is required, we have included two extra pages at the end so you can continue answering
your questions. Be sure you include the question number you are continuing to answer. This includes
extra entries for family members. Please ensure you enter all the same applicable information.

___________________________________ ___________________________________
NAME OF APPLICANT [PLEASE TYPE] DATE OF APPLICATION [YY-MMM-DD]

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 3

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
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All the items below must be uploaded with your application:

• Completed Lifestyle and Integrity Questionnaire
• Original Certified Educational Transcripts from High School and Post-Secondary
Institution
• International Credential Evaluation Services (ICES) Report (if applicable)
• Copy of Birth Certificate and Canadian Citizenship or Permanent Resident Documentation
• Copy of valid Standard First Aid Certificate with CPR “Level C” with AED
• Completed Visual Assessment Form
• Completed Audio Assessment Form
• Copy of Photo Identification - (Driver’s License)
• Driving Abstract
• Criminal pardon (if applicable)
• Two (2) Passport-sized photos wearing professional business attire
• Passing ETHOS score from other BC police agencies (if applicable)
• Criminal Record Check (if lived out of province for 6 months or more)

**INCOMPLETE APPLICATION WILL NOT BE HELD OR PROCESSED**

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 4

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
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FAMILY:
Surname: Given Name:
Previous Family Name: Middle Name:
Have you ever changed your ☐ Yes ☐ No
name?
Details:
Date of birth (yy-mmm-dd): Age:
Place of birth
Citizenship: Sin:
If Canadian by naturalization, provide date, certificate number and place of issue:

Address:
City: Province: Postal Code:
Driver’s License #: BC Phone (Home):
Phone (Cell): Phone (Business):
Email:
Additional Email Addresses:
Relationship Status: Date Relationship Started
(if applicable):
Emergency Contact: Relationship:
Contact Number:
If proficient in any other language(s) other than English – please specify:

PERSONAL INFORMATION:

If any person(s) listed for a relationship is deceased, the following details must be included in the two extra pages
at the end of the application: date of birth, last known address, and month and year deceased.

RELATIONSHIP INFORMATION:
1. Relationship: (e.g., spouse, girlfriend/boyfriend, common-law, significant other, includes dating partner)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone: Email:
Cell Phone: Business Phone:
Employer:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 5

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Employer’s Address:
Employer’s Phone:
To what degree do you financially support your child(ren) or former spouse?

DEPENDANTS:
Relationship: (e.g., Son, daughter, stepchild
with)
1. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
2. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
3. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
4. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 6

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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PARENTS:
1. Father: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
2. Mother: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
3. Parent: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
4. Parent: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 7

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
5. Spouse or Common Law Partner’s Parent: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
6. Spouse or Common Law Partner’s Parent: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
7. Spouse or Common Law Partner’s Parent: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
8. Spouse or Common Law Partner’s Parent: (includes natural, half, or step relatives)

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 8

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
SIBLINGS
1. Relationship: (e.g., Brother, sister, step sibling, half sibling)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
Occupation:
2. Relationship: (e.g., Brother, sister, step sibling, half sibling)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
Occupation:
3. Relationship: (e.g., Brother, sister, step sibling, half sibling)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
Occupation:
4. Relationship: (e.g., Brother, sister, step sibling, half sibling)

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 9

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
Occupation:

OTHER SIGNIFICANT FAMILY RELATIONSHIPS:

1. Additional Significant Family Member: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
2. Additional Significant Family Member: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:
3. Additional Significant Family Member: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 10

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Cell Phone: Email:

Employer:
Employer’s phone:
Occupation:
4. Additional Significant Family Member: (includes natural, half, or step relatives)
Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone: Email:
Employer:
Employer’s phone:
Occupation:

Do you correspond with or visit your parents? ☐ Yes ☐ No

Do you correspond with or visit your brothers/sisters? ☐ Yes ☐ No
At what age did you leave home?
Has any of your immediate family ever been arrested, charged, or convicted of a criminal offense?
☐ Yes ☐ No
If yes, provide brief details (Include year, place, and offence)

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 11

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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EDUCATION:
Secondary Education
1. From (mm/yyyy): To (mm/yyyy):
Name of Institution:
Location (Prov/State/Country):
Last completed Grade/Term:
2. From (mm/yyyy): To (mm/yyyy):
Name of Institution:
Location (Prov/State/Country):
Last completed Grade/Term:
Post-Secondary Education
1. From (mm/yyyy): To (mm/yyyy):
Name of Institution:
Credits Earned:
☐ Certificate/Diploma ☐ Degree
Program of Study: GPA:
2. From (mm/yyyy): To (mm/yyyy):
Name of Institution:
Credits Earned:
☐ Certificate/Diploma ☐ Degree
Program of Study: GPA:

EMPLOYMENT:
Start with your most recent employer and include any part-time employment and any employment while at
school. Add additional information to the two provided pages at the end if you require more space.
1. From (mm/yyyy): To (mm/yyyy):
☐ Part-Time ☐ Full-Time ☐ Seasonal Employment
Employer:
Employer’s Address:
Employer’s Telephone: Position:
Previous Positions (With same
employer)
Supervisor’s Name: Supervisor’s Title
Reason for leaving:
What do you like best about that position?

What do you like least about that position?

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 12

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Proudest achievements:

Biggest work-related disappointments:

What would you change about that position if you had the authority?

Can SPS contact this employer at this time? ☐ Yes ☐ No

2. From (mm/yyyy): To (mm/yyyy):

☐ Part-Time ☐ Full-Time ☐ Seasonal Employment
Employer:
Employer’s Address:
Employer’s Telephone: Position:
Previous Positions (With same
employer)
Supervisor’s Name: Supervisor’s Title
Reason for leaving:
What do you like best about that position?

What do you like least about that position?

Proudest achievements:

Biggest work-related disappointments:

What would you change about that position if you had the authority?

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 13

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Can SPS contact this employer at this time? ☐ Yes ☐ No

3. From (mm/yyyy): To (mm/yyyy):
☐ Part-Time ☐ Full-Time ☐ Seasonal Employment
Employer:
Employer’s Address:
Employer’s Telephone: Position:
Previous Positions (With same
employer)
Supervisor’s Name: Supervisor’s Title
Reason for leaving:
What do you like best about that position?

What do you like least about that position?

Proudest achievements:

Biggest work-related disappointments:

What would you change about that position if you had the authority?

Can SPS contact this employer at this time? ☐ Yes ☐ No

VOLUNTEER ACTIVITIES:
Start with your most recent volunteer activities. Add additional information to the two provided pages at the
end if you require space.
1. From (mm/yyyy): To (mm/yyyy):
Organization:
Organization’s Address:
Telephone: Position:
Previous Positions (With same
employer)

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 14

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Supervisor’s Name: Supervisor’s Title

Number of hours per month:
Reason for leaving:
Major assignments, challenges, responsibilities:

What do you like best about your position?

What do you like least about your position?

Proudest achievements:

Biggest disappointments:

2. From (mm/yyyy): To (mm/yyyy):

Organization:
Organization’s Address:
Telephone: Position:
Previous Positions (With same
employer)
Supervisor’s Name: Supervisor’s Title
Number of hours per month:
Reason for leaving:
Major assignments, challenges, responsibilities:

What do you like best about your position?

What do you like least about your position?

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 15

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Proudest achievements:

Biggest disappointments:

ASSOCIATIONS
List all persons (other than your spouse/partner or immediate family) with whom you have had regular contact
with over the past 5 years. Ask yourself, what people do you spend most of your time with?
1. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
2. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
3. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
4. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 16

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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Cell Phone:
5. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:
6. Relationship type:
Surname: Given:
Middle Name(s): Previous Family Name(s):
Date of birth Place of birth:
(yy-mmm-dd):
Address:
Home Phone:
Cell Phone:

RESIDENCES:
In chronological order, list your places of residence for the past five years, starting with the most recent.
1. From (mm/yyyy): To (mm/yyyy):
Address:

2. From (mm/yyyy): To (mm/yyyy):

Address:

3. From (mm/yyyy): To (mm/yyyy):

Address:

4. From (mm/yyyy): To (mm/yyyy):

Address:

5. From (mm/yyyy): To (mm/yyyy):

Address:

List residences outside of Canada where you have lived as an adult.

1. From (mm/yyyy): To (mm/yyyy):
Address:

2. From (mm/yyyy): To (mm/yyyy):

Address:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 17

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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OTHER POLICE AGENCIES:

List ALL police agencies where you have applied. Add additional information to the two provided pages at the
end if you require more space. Include law enforcement agencies you have applied to either as a civilian or
sworn member. Include law enforcement agencies such as Military Police, Customs, Sheriffs, Corrections,
Conservation Officer, CSIS, etc.
1. Police Organization: Date of Submission
(yy-mm-dd):
Stages Completed:
Exam Score Exam Date POPAT Score POPAT Date
Current Application Status:
If removed from process, state the reason you believed you were removed.

2. Police Organization: Date of Submission

(yy-mm-dd):
Stages Completed:
Exam Score Exam Date POPAT Score POPAT Date
Current Application Status:
If removed from process, state the reason you believed you were removed.

3. Police Organization: Date of Submission

(yy-mm-dd):
Stages Completed:
Exam Score Exam Date POPAT Score POPAT Date
Current Application Status:
If removed from process, state the reason you believed you were removed.

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 18

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
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FINANCIAL:
As part of the background investigation and to obtain a valid security clearance, a credit check is required.
Do you consent to SPS conducting a credit check? ☐ Yes ☐ No
Section 1 – Please list all your assets you exclusively own
A. B. C. D.
Asset Classification (Real Current estimated market Current Equity (B minus C) current
estate, Savings, Vehicle, vale of assets mortgage/loan/lien on value minus loan
Stocks, Investments etc.) asset
0
0
0
0
Total: 0
Section 2 – Please list all your SHARED assets you own (e.g. with spouse, family, common-law, etc.)
A. B. C. D. E.
Asset Classification Current estimated Current Percentage of your Equity (B minus C,
(Real estate, Savings, market value of mortgage/loan/lien ownership (%) multiplied by D)
Vehicle, Stocks, assets on asset Current value minus
Investments etc.) loan x your
percentage of
ownership

Total: 0
Section 3 – Please list all other sources in income.
A. B.
Category (Salary, rent, dividend etc.) Monthly Income

Total: 0
Section 4 – Please list your debts
A. B. C. D.
Category (Loans, Credit Original Amount Current Amount Monthly Payment
Cards, Line of Credit, Child
support etc.)

Total: 0

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 19

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

Do you have any debts that are in default or overdue? If yes, provide details ☐ Yes ☐ No

What is your annual gross income?

1. Have you been bonded? If yes, provide details [When, where circumstances] ☐ Yes ☐ No

SPS Notes:
2. Have you declared bankruptcy? If yes, provide details [When, where, circumstances] ☐ Yes ☐ No

SPS Notes:
3. Has a collection agency collected or attempted to collect an outstanding debt from you? ☐ Yes ☐ No
If yes, provide details [When, where, circumstances]

SPS Notes:
4. Have you knowingly written an NSF cheque? If yes, provide details [When, where ☒ Yes ☐ No
circumstances]

SPS Notes:

GENERAL INFORMATION:
1. Name three things you have done, for which you are most proud:

SPS Notes:
2. Name three things you have done, for which you are not proud of:

SPS Notes:
AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 20

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

3. What are your plans for the next five years?

SPS Notes:
4. What actions have you taken to implement these plans?

SPS Notes:
5. Have you been refused entry to any country? If yes, please provide details including year, ☐ Yes ☐ No
country, port of entry denied, and reason.

SPS Notes:
6. Are you aware of any reason why you may be disqualified as a potential employee of ☐ Yes ☐ No
Surrey Police Service? If yes, please provide details.

SPS Notes:
7. Are you currently or have you in the past been involved in a civil lawsuit as a plaintiff, ☐ Yes ☐ No
defendant, third party, petitioner, respondent or witness?

SPS Notes:
8. Has your status in Canada been investigated by a hearing or tribunal? If yes, by what ☐ Yes ☐ No
agency? Please provide details.

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 21

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

SOCIAL MEDIA:
1. Please list any social media accounts or any public forums you are active in. Please provide all of your social
media Username ID’s.

2. Have you engaged/posted on social media or any forums which are or could become public ☐ Yes ☐ No
related to SPS or SPS transition issues in support or otherwise? If yes, please provide details
(where, when, context, etc.) SPS may require that you provide copies.

3. Do you consent to SPS reviewing your social media accounts and forums listed above? ☐ Yes ☐ No

DRIVING INFORMATION:
1. List all driving offenses for which you have ever received a ticket, including photo radar and out of province
[include the year of the ticket(s)]

SPS Notes:
2. Have you failed to appear in court in relation to a traffic violation? ☐ Yes ☐ No
Have you had a driver’s license suspended or revoked? ☐ Yes ☐ No
Have you driven while under suspension, prohibition, or without a license? ☐ Yes ☐ No
Have you been refused automobile insurance or have had it cancelled or suspended? ☐ Yes ☐ No
Have you ever received a letter about too many tickets? ☐ Yes ☐ No
If yes, please provide details [when, where, and circumstances]:

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 22

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

3. Have you ever been involved in any motor vehicle accidents? ☐ Yes ☐ No
Have you received insurance settlements resulting from a motor vehicle accident? ☐ Yes ☐ No
If yes, please provide details [when, where, and circumstances] and indicate if you were at
fault:

SPS Notes:
4. Have you falsified, exaggerated, or lied about an insurance claim of any kind? If, yes, please ☐ Yes ☐ No
provide details [when, where, and circumstances]:

SPS Notes:
5. Have you been involved in a hit-and-run accident either as a driver or a passenger – no ☐ Yes ☐ No
matter how minor the damage? If, yes, please provide details [when, where, and
circumstances]:

SPS Notes:
6. Have you deliberately left the scene of an accident you were involved in? If, yes, please ☐ Yes ☐ No
provide details [when, where, and circumstances]:

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 23

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

EDUCATION:
1. Have you ever required additional assistance, support, or accommodations to achieve a passing grade ☐ Yes ☐ No
for an exam or course at any point during your education? This would include extra support for a
learning disability or been assigned an Independent Education Plan (IEP)?If yes, please provide details.

SPS Notes:
2. Have you ever cheated on an exam and/or plagiarized an essay or academic piece of work? ☐ Yes ☐ No
If, yes, please provide details [when, where, and circumstances]:

SPS Notes:
3. Have you been suspended or formally reprimanded by an educational institution? If yes, ☐ Yes ☐ No
please provide details [When, where and circumstances, include academic suspensions]

SPS Notes:

EMPLOYMENT:
1. Have you held any employment or volunteer activities that you have not disclosed in this ☐ Yes ☐ No
application process? If yes, please provide details [when, where, and circumstances].

SPS Notes:
2. Have you held employment under another name? If, yes, please provide details [name, ☐ Yes ☐ No
when, where, and circumstances]:

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 24

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

3. Have you been disciplined/documented for inappropriate behavior at work? If yes, please ☐ Yes ☐ No
provide details [When, where and circumstances]

SPS Notes:
4. Have you been unemployed for extended periods of time? ☐ Yes ☐ No
Have you collected employment insurance benefits of welfare? ☐ Yes ☐ No
Have you worked while on employment insurance or welfare and not reported your full ☐ Yes ☐ No
earnings?
If yes to any of the above, please provide details [when, where, and
circumstances]:

SPS Notes:
5. Have you been unable to work for periods of 4 weeks or more due to an illness or injury? If ☐ Yes ☐ No
yes, please provide details [when, where and circumstances]

SPS Notes:
6. Have you booked off sick when you have not been? If yes, please provide details [How ☐ Yes ☐ No
many times, why, when was the last time]

SPS Notes:
7. Have you had problems with being late when you were a student or an employee? If yes, ☐ Yes ☐ No
please provide details [When, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 25

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

DRUGS AND ALCOHOL:

1. Have you thought you were using, tested, sniffed, smoked, ingested, inhaled, injected, swallowed, attempted
to use or experimented with any form of controlled drugs or substances such as but not limited to:
COCAINE ☐ Yes ☐ No # of times: When:
(yy-mmm)
CRACK ☐ Yes ☐ No # of times: When:
(yy-mmm)
ECSTACY ☐ Yes ☐ No # of times: When:
(yy-mmm)
HEROIN ☐ Yes ☐ No # of times: When:
(yy-mmm)
LSD ☐ Yes ☐ No # of times: When:
(yy-mmm)
CANNABIS ☐ Yes ☐ No # of times: When:
(yy-mmm)
METHAMPHETAMINE ☐ Yes ☐ No # of times: When:
(yy-mmm)
MUSHROOMS ☐ Yes ☐ No # of times: When:
(yy-mmm)
PCP ☐ Yes ☐ No # of times: When:
(yy-mmm)
SPEED ☐ Yes ☐ No # of times: When:
(yy-mmm)
DESIGNER DRUGS ☐ Yes ☐ No # of times: When:
(yy-mmm)
INHALENTS [GAS/GLUE] ☐ Yes ☐ No # of times: When:
(yy-mmm)
OTHER ☐ Yes ☐ No # of times: When:
(provide details below) (yy-mmm)

2. Please provide further details on your drug use, frequency and time frames: ☐ N/A

SPS Notes:
3. Do you possess, or have you possessed a medicinal cannabis card? If so, detail the reason ☐ Yes ☐ No
you possessed such a card?

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 26

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

4. When did you last use a controlled drug or substance? What were the circumstances? What ☐ N/A
type of drug?

SPS Notes:
5. Have you purchased controlled drugs or substances? If yes, please provide details [When, ☐ Yes ☐ No
where, circumstances, and type of drug)

SPS Notes:
6. Have you sold controlled drugs or substances or illegally sold prescription drugs? If yes, ☐ Yes ☐ No
please provide details [When, where, circumstances, and type of drug]

SPS Notes:
7. Have you grown/ manufactured/ imported/ transported controlled drugs or substances? If ☐ Yes ☐ No
yes, please provide details [When, where, circumstances, and type of drug]

SPS Notes:
8. Do you know anyone who has ever sold, grown, or manufactured, imported, or transported ☐ Yes ☐ No
controlled drugs or substances? If yes, please provide details [When, where and circumstances]

SPS Notes:
9. Have you been in a place where you knew controlled drugs or substances or narcotics were ☐ Yes ☐ No
being used? If yes, please provide details [When, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 27

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

10. Have you allowed someone to use controlled drugs or substances at your residence or in ☐ Yes ☐ No
your vehicle? If yes, please provide details [When, where and circumstances]

SPS Notes:
11. Have you used or sold steroids and/or other performance enhancing drugs? If yes, please ☐ Yes ☐ No
provide details [When, where and circumstances]

SPS Notes:
12. Have you administered a controlled drug, substance, or intoxicant to a person without their ☐ Yes ☐ No
knowledge or consent? If yes, please provide details [When, where and circumstances]

SPS Notes:
13. Have you misused prescription drugs? If yes, please provide details [when, where and ☐ Yes ☐ No
circumstances]

SPS Notes:
14. Have you misused non-prescription drugs? If yes, please provide details [When, where and ☐ Yes ☐ No
circumstances]

SPS Notes:
15. Have you driven a motor vehicle, boat or other vehicle while you have been under the ☐ Yes ☐ No
influence of drugs/alcohol? If yes, please provide details [when, where & circumstances, what
drug/alcohol did you use]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 28

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

16. Have you worked while you have been impaired or unfit under the influence of drugs/ ☐ Yes ☐ No
alcohol? If yes, please provide details [When, where and circumstances, what drug/alcohol
did you use]

SPS Notes:
17. Have you been in a verbal or physical altercation while under the influence of alcohol or ☐ Yes ☐ No
drugs? If yes, please provide details [When, where and circumstances]

SPS Notes:
18. Have you been charged for an offence involving the consumption, transportation, or ☐ Yes ☐ No
distribution of alcohol? If yes, please provide details [When, where and circumstances]

SPS Notes:
19. How many times have you driven a motor vehicle, boat, or other vehicle while you have been under the
influence of alcohol and thought you were over the legal alcohol limit? Please provide details [When, where and
circumstances]

SPS Notes:
20. Provide details about the last time you drove when you thought you were over the legal alcohol limit. How
many drinks did you have and over what period? How many times in total? When did this occur?

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 29

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

FIREARMS:
1. Have you had possession of an illegal or unregistered firearm or other weapons? Please ☐ Yes ☐ No
provide details [When, where and circumstances]

SPS Notes:

LIFESTYLE AND INTEGRITY:

1. Have you been in a physical altercation with a spouse/ex-spouse, partner or anyone ☐ Yes ☐ No
associated to you in a domestic or family relationship? If yes, please provide details [when,
where and circumstances]

SPS Notes:
2. Have you been in a physical fight or assaulted anyone? [sports or otherwise, regardless of ☐ Yes ☐ No
your age at the time] If yes, please provide details [when, where and circumstances]

SPS Notes:
3. Have you been physically violent towards a child? If yes, please provide details [when, ☐ Yes ☐ No
where and circumstances]

SPS Notes:
4. Have you had sexual involvement with anyone without their consent? If yes, please ☐ Yes ☐ No
provide details [when, where and circumstances]

SPS Notes:
5. Have you been involved in sexual activity where money has been exchanged? If yes, ☐ Yes ☐ No
please provide details [when, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 30

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

6. Have you been involved in the sex trade industry, in any capacity? If yes, please provide ☐ Yes ☐ No
details [when, where and circumstances]

SPS Notes:
7. Have you retained or participated in any type of commercial sexual activity for yourself or ☐ Yes ☐ No
others, either in Canada or abroad? If yes, please provide details [when, where and
circumstances]

SPS Notes:
8. Have you been involved in a sexual manner with a child, underage person or anyone ☐ Yes ☐ No
purported to be a child or underage person? If yes, please provide details [when, where and
circumstances]

SPS Notes:
9. Have you committed a sexual act that if you were caught, you might have been ☐ Yes ☐ No
prosecuted (bestiality, indecent exposure, voyeurism, incest, sex in public, anonymous
harassing phone calls, digital image and/or video recording people without permission)? If
yes, please provide details [when, where and circumstances]

SPS Notes:
10. Have you used the internet to communicate in an inappropriate manner with a child, ☐ Yes ☐ No
underage person, or anyone purported to be a child or underage person? If yes, please
provide details [when, where and circumstances]

SPS Notes:
11. Have you recorded and/or distributed, by any media, sexual acts of another person in a ☐ Yes ☐ No
public area or in a location where there was a reasonable expectation of privacy without
their consent? If yes, please provide details [when, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 31

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

12. Have you had possession of or viewed any material that could be considered child, ☐ Yes ☐ No
violent or animal pornography? If yes, please provide details [when, where and
circumstances]

SPS Notes:
13. Have you used a name other than your own for any purpose, including false ☐ Yes ☐ No
identification? If yes, please provide details [when, where and circumstances]

SPS Notes:
14. Have you falsified an official document, including by electronic means? If yes, please ☐ Yes ☐ No
provide details [when, where and circumstances]

SPS Notes:
15. Have you told a lie or misrepresentation of any act, while under oath, or on a sworn or ☐ Yes ☐ No
notarized document? If yes, please provide details [when, where and circumstances]

SPS Notes:
16. Have you been the subject of a restraining order? If yes, please provide details [when, ☐ Yes ☐ No
where and circumstances]

SPS Notes:
17. Do you currently associate with, or have you in the past, associated with individuals or ☐ Yes ☐ No
groups, including a family member, whom you know to be engaged in criminal activity? If
yes, please provide details [when, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 32

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

18. Have you visited a “clubhouse”, residence, or any other place used by a criminal ☐ Yes ☐ No
organization, gang, or persons involved in criminal activity? If yes, please provide details
[when, where and circumstances]

SPS Notes:
19. Do you gamble? If yes, please provide details [when, where and circumstances] ☐ Yes ☐ No
Do you have any gambling debts? If yes, please provide details ☐ Yes ☐ No

SPS Notes:
20. Do you currently associate with a criminal organization, gang or member of a gang? If ☐ Yes ☐ No
yes, please provide details [when, where and circumstances]

SPS Notes:
21. Have you in the past associated or been connected in any way to a criminal organization, ☐ Yes ☐ No
gang or member of a gang? If yes, please provide details [when, where and circumstances]

SPS Notes:
22. Are you engaged in a business as an owner or partner? (Active partner/owner or silent ☐ Yes ☐ No
partner) If yes, please provide details [when, where and circumstances]

SPS Notes:
23. Have you filed an inaccurate tax return [did not declare all income, etc.]? ☐ Yes ☐ No
Have you failed to file your income tax return? ☐ Yes ☐ No
Have you filed a late income tax return? ☐ Yes ☐ No
Are you responsible for filing your tax return? ☐ Yes ☐ No
If yes, please provide details [when, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 33

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

24. Have you failed to declare everything or made a false declaration at the Canada-USA ☐ Yes ☐ No
border or other international border? If yes, please provide details [when, where and
circumstances]

SPS Notes:
25. Have you been fired, laid off or let go from a job? ☐ Yes ☐ No
Have you ever resigned from a job to avoid termination of employment? ☐ Yes ☐ No
If yes to either question, please provide details [when, where and circumstances]

SPS Notes:
26. Have you committed a theft from any of your employers? If yes, please provide details ☐ Yes ☐ No
[when, where and circumstances]

SPS Notes:
27. Have you been involved in any other thefts [shoplifting, price tag switching, theft from ☐ Yes ☐ No
parents, etc.]? If yes, please provide details [when, where and circumstances]

SPS Notes:
28. Have you had possession of anything obtained through the commission of any offence? ☐ Yes ☐ No
If yes, please provide details [when, where and circumstances]

SPS Notes:
29. Have you intentionally damaged someone else’s property? If yes, please provide details ☐ Yes ☐ No
[when, where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 34

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

30. Do you currently have outstanding fines [traffic, parking violations, etc.]? If yes, please ☐ Yes ☐ No
provide details [when, where and circumstances]

SPS Notes:
31. Have you been investigated, arrested, charged, or convicted of a regulatory or criminal ☐ Yes ☐ No
offence, including abroad? If yes, please provide details [when, where and circumstances]

SPS Notes:

32. Have you been subject to any of the following by the police? (Including any police investigations you may be
associated with, including in a foreign country):
Checked ☐ Yes ☐ No Ticketed ☐ Yes ☐ No
Detained ☐ Yes ☐ No Driven Home ☐ Yes ☐ No
Questioned ☐ Yes ☐ No Arrested ☐ Yes ☐ No
If you answered yes to any of the above, please provide details [when, where and circumstances]:

SPS Notes:
33. Have you been chased, pursued, or hid from the police? If yes, please provide details ☐ Yes ☐ No
[when, where and circumstances]

SPS Notes:
34. Have you hidden anyone or helped anyone avoid being arrested or found by the police? ☐ Yes ☐ No
If yes, please provide details [when, where and circumstances]

SPS Notes:
35. Have you engaged in cruelty to any creature or animal that resulted in harm, injury, or ☐ Yes ☐ No
death, other than legally licensed hunting or fishing? If yes, please provide details [when,
where and circumstances]

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 35

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

36. Have you participated in unlawful acts that you have not already disclosed to us? If yes, ☐ Yes ☐ No
please provide details [when, where and circumstances]

SPS Notes:
37. Have you caused the death of another person? If yes, please provide details [when, ☐ Yes ☐ No
where and circumstances]

SPS Notes:
38. Have you contributed to the death of another person? If yes, please provide details ☐ Yes ☐ No
[when, where and circumstances]

SPS Notes:
39. Do you currently or have you worked or volunteered in a policing environment? If you ☐ Yes ☐ No
have answered yes to this question, please answer the following two questions, and provide
details [when, where and circumstances]:
A. Are you currently the subject of an internal or external investigation? ☐ Yes ☐ No
B. Have you been formally investigated for any situations while working or volunteering in a policing ☐ Yes ☐ No
environment?
C. Have you been dismissed from any volunteer position you have held? If yes, please provide details ☐ Yes ☐ No

SPS Notes:
40. A background check is part of the selection process. It involves a detailed and thorough ☐ Yes ☐ No
investigation of your history. Is there any information you wish to add or disclose that you
believe SPS should be aware of at this time? Please remember, non-disclosures may affect
the status of your application. If yes, please provide details below:

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 36

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

41. Is there any reason why you could NOT perform the duties of the position for which you ☐ Yes ☐ No
are applying?

SPS Notes:

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 37

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

BACKGROUND CHECK:

Should you have any questions or concerns, contact the Recruiting Section. All issues must be disclosed in
advance of the polygraph examination or disqualification will be considered.

CLOSING DECLARATION

I hereby certify that the answers given by me in this integrity and lifestyle questionnaire are correct,
and that all statements in this integrity and lifestyle questionnaire are true and complete. Employment
with Surrey Police Service is requiring upon successful completion of all phases of the application process.
I understand that deceit, dishonesty, or non-disclosure concerning questions in this document, or during
any other stage of the application process, will result in my disqualification from this and any other future
competitions or will result in dismissal. I understand that any information received from inquiries made
concerning statements in this questionnaire will not be disclosed to me. I understand that information
supplied in this document and obtained during the application process will be considered in the context
of the competition and will be held in confidence under those circumstances; with the exception that this
information may be made available to other police agencies in Canada and, if applicable any future
employment or volunteer positions with Surrey Police Service.

________________________________________ ______________________________________

Name of Applicant Date of Application

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 38

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

PERSONAL INFORMATION AND

REFERENCE CHECK RELEASE FORM

Name of Applicant: _________________________________

Position: _________________________________

Applicant Authorization for Surrey Police Service to Collect Personal Information

I have applied to Surrey Police Service (“SPS”) for employment. I am aware the hiring process includes a
detailed investigation conducted by SPS or its authorized agents/representatives, including a review of any
information I have provided as part of the application process and during interviews, as well as the collection
and review of any information that is publicly available, or could be made publicly available, about me
(including through internet searches and on social media sites). I acknowledge the investigation may include
reference checks and communications with my current and former employers, educational institutions,
volunteer organizations and others.

I HEREBY AUTHORIZE AND CONSENT to the release of any information about me, including personal
information, to SPS and its authorized agents/representatives that may be relevant to my application for
employment with SPS, including but not limited to my current and past employment (including job
performance), education, volunteering, and character, by any person who may have knowledge of, or access
to the requested information.

Type your name (this will be your legal signature), and date before submitting your reference list.

_______________________________________ ___________________
Applicant Name (Type) Date

_______________________________________ ___________________
Witness Name (Type) Date

If you have any questions about this consent to receive personal information, please contact SPS Recruiting
Section at careers@surreypolice.ca

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 39

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 40

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.
 Integrity and Lifestyle Questionnaire - Recruit
AD-3303

AD-3303 Integrity and Lifestyle Questionnaire

.CC Employee File Form created/modified: March 28, 2024 CONFIDENTIAL 41

See Policy AD 3.3
Surrey Police Service is collecting this information under section 26(c) of the Freedom of Information and Protection of Privacy Act.
For questions regarding the collection of personal information on this form please contact the Manager of Information and Privacy, FOI@surreypolice.ca.