Form 1 Appendix E "Application Form" - Nunavut, Canada

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APPENDIX ‘E’
FORM #1 – APPLICATION FORM
Justice of the Peace Program
APPLICATION FORM
Name:_____________________________
.__________________
S.I.N
Address:________________________________________________________________
Ph: (H) 867-
(w) 867-
Fax: 867-
e-mail:
Date of Birth:_____________________ Female
Male
Canadian citizen? Yes
No
Spouse:
Children still at home, name and age (If you need more space add them on the back)
Education:_________________________________________________________
Occupation:____________________________________________________________
Name of Employer:____________________________________________________
How long have you been a resident in the area?________________
In what languages are you fluent?
Oral:______________________________________________________________
Written:___________________________________________________________
I hereby authorize the RCMP to provide the administrator, Justice of the Peace Program, Department of
Justice, Nunavut with the results of a Criminal Record Check.
Signature:__________________________ Date:_______________________
In order to be a Justice of the Peace, you must be a Canadian citizen and a resident of Nunavut for at
least 6 months prior to your application. Members of Nunavut Legislature or Hamlet Councils are not
eligible to become Justices of the Peace.
Please return this application to: Administrative Assistant, Justice of the Peace Program or Senior Justice of the Peace
NCJ.JP@gov.nu.ca
APPENDIX ‘E’
FORM #1 – APPLICATION FORM
Justice of the Peace Program
APPLICATION FORM
Name:_____________________________
.__________________
S.I.N
Address:________________________________________________________________
Ph: (H) 867-
(w) 867-
Fax: 867-
e-mail:
Date of Birth:_____________________ Female
Male
Canadian citizen? Yes
No
Spouse:
Children still at home, name and age (If you need more space add them on the back)
Education:_________________________________________________________
Occupation:____________________________________________________________
Name of Employer:____________________________________________________
How long have you been a resident in the area?________________
In what languages are you fluent?
Oral:______________________________________________________________
Written:___________________________________________________________
I hereby authorize the RCMP to provide the administrator, Justice of the Peace Program, Department of
Justice, Nunavut with the results of a Criminal Record Check.
Signature:__________________________ Date:_______________________
In order to be a Justice of the Peace, you must be a Canadian citizen and a resident of Nunavut for at
least 6 months prior to your application. Members of Nunavut Legislature or Hamlet Councils are not
eligible to become Justices of the Peace.
Please return this application to: Administrative Assistant, Justice of the Peace Program or Senior Justice of the Peace
NCJ.JP@gov.nu.ca