Application for Horse Racing Licence and Registration - British Columbia Canada Download Printable PDF

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Application for Horse Racing

Licence and Registration

Gaming Policy and Enforcement Branch – Racing Division

Hastings Racecourse

Fraser Downs Raceway

Mail/Courier: #408-4603 Kingsway, Burnaby, BC V5H 4M4

Telephone: (604) 660-9090

Telephone: (604) 576-3727

Telephone: (604) 660-7407

Fax: (604) 660-7414

Fax: (604) 775-1752

Fax: (604) 576-7910

Web:

www.gaming.gov.bc.ca

BEFORE YOU START

Use this form to apply for a licence to work in the horse racing industry in British Columbia.



Applications must include a non-refundable application fee of $30 (cash, money order, or cheque payable to the “Minister of Finance”).



Applications must include copies of two pieces of personal identification, including one piece of picture identification.



Applications must be completed in full; signature is required in Section 5.

SECTION 1 – APPLICANT INFORMATION

PLEASE PRINT CLEARLY

Surname: (current legal surname)

First name: (legal first name)

Middle name(s): (legal middle names)

Licence type:

Racetrack name:

Medical number: (if you are a rider / driver)

Advised: (signature of judge / steward)

Previous licence type:

Previous racetrack name:

Year of previous licence:

Address: (current address) Unit and Street

City

Province

Postal Code

Home phone number: (XXX) XXX-XXXX

Work phone number: (XXX) XXX-XXXX

Email or Text (SMS):

Date of birth: (YYYY-MM-DD)

Gender:

City of birth:

Country of birth:

Are you a Canadian citizen:

Immigration status: (i.e. visitor, working visa, landed immigrant, etc.)

If NO, you must supply landed immigrant or

Yes

work permit documents.

Spouse’s full name: (surname, first name, middle names)

Social Insurance Number:

Married:

Yes

Former surnames, legal name changes, or any nicknames: (attach a separate sheet if more space is required)

Surname:

First name:

Middle name:

Date: (YYYY-MM-DD)

Places of residence for the last five years: (city and province/state only – attach a separate sheet if more space is required)

City:

Province/State:

City:

Province/State:

GAMING POLICY AND ENFORCEMENT BRANCH USE ONLY

Expiry date:

New/renewal:

Occupational season:

Licence #:

Location of issue:

Receipt #:

Date:

(T)BRED or (S)BRED:

GBC ID #:

Application #:

Keep your personal information safe. Your completed electronic or paper copy of this form

June 15, 2016

should be stored in a safe and secure place, or destroyed in a secure manner.

Page 1 of 4

Save Form

Print Form

Clear Form

Application for Horse Racing

Licence and Registration

Gaming Policy and Enforcement Branch – Racing Division

Hastings Racecourse

Fraser Downs Raceway

Mail/Courier: #408-4603 Kingsway, Burnaby, BC V5H 4M4

Telephone: (604) 660-9090

Telephone: (604) 576-3727

Telephone: (604) 660-7407

Fax: (604) 660-7414

Fax: (604) 775-1752

Fax: (604) 576-7910

Web:

www.gaming.gov.bc.ca

BEFORE YOU START

Use this form to apply for a licence to work in the horse racing industry in British Columbia.



Applications must include a non-refundable application fee of $30 (cash, money order, or cheque payable to the “Minister of Finance”).



Applications must include copies of two pieces of personal identification, including one piece of picture identification.



Applications must be completed in full; signature is required in Section 5.

SECTION 1 – APPLICANT INFORMATION

PLEASE PRINT CLEARLY

Surname: (current legal surname)

First name: (legal first name)

Middle name(s): (legal middle names)

Licence type:

Racetrack name:

Medical number: (if you are a rider / driver)

Advised: (signature of judge / steward)

Previous licence type:

Previous racetrack name:

Year of previous licence:

Address: (current address) Unit and Street

City

Province

Postal Code

Home phone number: (XXX) XXX-XXXX

Work phone number: (XXX) XXX-XXXX

Email or Text (SMS):

Date of birth: (YYYY-MM-DD)

Gender:

City of birth:

Country of birth:

Are you a Canadian citizen:

Immigration status: (i.e. visitor, working visa, landed immigrant, etc.)

If NO, you must supply landed immigrant or

Yes

work permit documents.

Spouse’s full name: (surname, first name, middle names)

Social Insurance Number:

Married:

Yes

Former surnames, legal name changes, or any nicknames: (attach a separate sheet if more space is required)

Surname:

First name:

Middle name:

Date: (YYYY-MM-DD)

Places of residence for the last five years: (city and province/state only – attach a separate sheet if more space is required)

City:

Province/State:

City:

Province/State:

GAMING POLICY AND ENFORCEMENT BRANCH USE ONLY

Expiry date:

New/renewal:

Occupational season:

Licence #:

Location of issue:

Receipt #:

Date:

(T)BRED or (S)BRED:

GBC ID #:

Application #:

Keep your personal information safe. Your completed electronic or paper copy of this form

June 15, 2016

should be stored in a safe and secure place, or destroyed in a secure manner.

Page 1 of 4

Gaming Policy and Enforcement Branch

Application for Horse Racing Licence and Registration

SECTION 2 – DETAILS OF LICENSEE AUTHORIZATIONS

Authorized agent(s) name(s):

Trainer(s) name(s):

Jockey’s agent(s) name(s):

SECTION 3 – TRAINED OR OWNED HORSES ON FILE WITH THE RACING SECRETARY

Trained or owned horses: (list horses on file with the Racing Secretary)

Name of horse:

Name of owner / partnership / stable / company:

SECTION 4 – DISCLOSURE

Full disclosure of all incidents and offences is required, including Young Offender information pursuant to Section 119(1)(o) of the Youth Criminal Justice

Act. Failure to fully disclose all incidents and offences is deemed sufficient grounds to deny your application.

1. Have you in the last 10 years,

Arrested

Yes

in any jurisdiction, been:

Stopped or Detained (such as for shoplifting or impaired driving)

Yes

Charged with any criminal offence, whether found guilty or not

Yes

Diverted or received Alternate Justice (such as for theft, shoplifting)

Yes

Convicted of any criminal offence, regardless of the sentence

Yes

Investigated by police, loss prevention or other authority for any criminal offence

Yes

Cases: (complete this section if you answered YES to any of the above – provide details as indicated below – list all cases without exception including

those in which you were not charged or convicted – attach a separate sheet if more space is required)

Date of Arrest / Detention:

Location:

(YYYY-MM-DD)

Age:

Charge / Claim:

(City, Prov / State)

Disposition:

Arresting Agency:

2. Have you, in any racing jurisdiction, been denied any licence or had any licence revoked?

Yes

3. Have you, in any racing jurisdiction, had any fines or suspensions?

Yes

4. Have you ever had a judgement against you in a civil action?

Yes

5. Have you declared bankruptcy or received assistance from a regulatory body or a court because of an outstanding debt?

Yes

If you answered YES to any of questions 2-5 above, provide details below: (attach a separate sheet if more space is required)

Keep your personal information safe. Your completed electronic or paper copy of this form

June 15, 2016

should be stored in a safe and secure place, or destroyed in a secure manner.

Page 2 of 4

Gaming Policy and Enforcement Branch

Application for Horse Racing Licence and Registration

SECTION 5 – CONSENT TO RELEASE PERSONAL INFORMATION AND CERTIFICATION

NOTE: Applicants must provide their signature in the space provided below to indicate they understand and agree to the following.

Consent to Release Personal Information (signature required below)

Background Checks and Release of Personal Information

I hereby authorize:

Background checks will include but are not limited to credit history, criminal

record and local indices checks. The Canadian Police Information Centre

1. The Gaming Policy and Enforcement Branch (GPEB) to investigate my

(CPIC) database records will be queried for the disposition of all charges for

suitability for Registration in the gaming industry pursuant to Part 7 and 8

which a person has been fingerprinted (Criminal Record) and all outstanding

of the Gaming Control Act and Gaming Control Regulation. I understand

charges currently before the courts. Local indices checks will be conducted

that GPEB is required to protect the confidentiality and privacy of personal

through the RCMP PIRS, PROS, PRIME and LEIP and any other City,

information provided, in accordance with The Freedom of Information and

Municipal, Provincial, Federal, State, County, Sheriffs, FBI or other police

Protection of Privacy Act (British Columbia).

databases in Canada or the USA that GPEB deems appropriate. These

databases record all complaints the respective police departments investigate

2. Any City, Municipal, or Provincial Police department or public body

and include information related to non convictions and charges regardless of

including GPEB, pursuant to Section 33 of the Freedom of Information and

disposition. Therefore full disclosure of all criminal and civil proceedings is

Protection of Privacy Act (British Columbia), and the Royal Canadian

required and each case will be decided on its own merit. If necessary, an

Mounted Police pursuant to Section 8 (1) of the Privacy Act of Canada, to

applicant will be required to provide fingerprints to verify whether or not they

release any and all personal information and records, (including

have a criminal record.

convictions, non convictions and charges regardless of disposition)

retained by them in their files, including PIRS, CPIC, PROS, PRIME and

You must provide GPEB with the written authorization necessary to allow the

LEIP or any other local indices and databases, and necessary for GPEB to

police or other public bodies to release relevant information including

perform registration and enforcement responsibilities under the Gaming

information relating to the Young Offenders Act to GPEB for the purposes of

Control Act.

registration and enforcement of the Gaming Control Act. The information

requested is collected under the authority of the Gaming Control Act [SBC

3. Any Organization pursuant to Section 6 (2) (a) of the Personal

2002].

Information Protection Act (British Columbia), to disclose my personal

information to GPEB in order for GPEB to conduct a background

investigation in accordance with the Gaming Control Act.

4. GPEB and any Police Departments, Public Bodies or Organizations

noted in paragraphs 2 and 3 above to utilize this consent to conduct any

future background checks and/or release any documents necessary to

continue registration or to approve any subsequent applications, including

electronic applications, submitted to renew registration.

5. GPEB to release my personal identification information (name, date of

birth, address and telephone number) to The Association of Racing

Commissioners International (ARCI) for the purpose of recording race

findings within the horse racing industry in North America.

Certification (signature required below)

I certify that all of the information provided by me in this application for a

horse racing licence/registration is true to the best of my knowledge and

belief.

I understand that any false or inaccurate statements made in this application

for horse racing licence / registration, or failure to disclose may be deemed

sufficient cause for rejection of my application by the Gaming Policy and

Enforcement Branch.

I certify that I have read and understand the conditions of registration

included with this application.

Signature of applicant:

Name: (print your full name)

Effective today: (YYYY-MM-DD)

GAMING POLICY AND ENFORCEMENT BRANCH USE ONLY

Application complete

Photo

Fee enclosed

Equifax

CPIC

Interpol

PIRS/PRIME __________

PROS/LEIP

JUSTIN

Online Service

Other ______________________

Date:

Investigator:

Approved

Rejected

Keep your personal information safe. Your completed electronic or paper copy of this form

June 15, 2016

should be stored in a safe and secure place, or destroyed in a secure manner.

Page 3 of 4

Gaming Policy and Enforcement Branch

Application for Horse Racing Licence and Registration

SECTION 6 – CONDITIONS OF REGISTRATION

Failure to comply with any of the following conditions may be grounds for the Director of Registration to cancel registration. Registration may

not be transferred to any person.

Compliance required:

A registrant shall comply with:

Applicable legislation;

Lawful policies, orders and directions of the province and its agents;

Conditions set out in this policy or from time to time established by the Director of Registration;

Specific conditions, if any, established by the Director of Registration for the registrant; and

The rules of racing and accept and abide by the rulings and decisions of the stewards / judges, and racing officials.

The Horse Racing Identification Licence must be carried at all times when on the grounds of a horse racing event and must be produced

immediately when requested by an official of the Gaming Policy and Enforcement Branch.

Director of Registration to be notified on certain events:

A registrant must immediately notify the Director of Registration in writing if:

The registrant changes his or her name.

The registrant is under criminal investigation or is charged or has charges pending in relation to a criminal matter.

A civil suit involving allegations of fraud, theft, deceit, misrepresentation or similar conduct is commenced against the registrant.

How the Director of

By Mail:

By Fax:

Registration is Notified

Director of Registration

Victoria (250) 356-0782

P.O. Box 9202 Stn. Prov. Govt

Victoria, BC V8W 9J1

How to Contact the

By Mail:

By Phone or Fax:

Horse Racing Division

Executive Director of Horse Racing

Main Office

Hastings Racecourse

Fraser Downs Raceway

#408-4603 Kingsway Avenue

Tel: (604) 660-7407

Tel: (604) 660-9090

Tel: (604) 576-3727

Burnaby, BC V5H 4M4

Fax: (604) 660-7414

Fax: (604) 775-1752

Fax: (604) 576-7910

Keep your personal information safe. Your completed electronic or paper copy of this form

June 15, 2016

should be stored in a safe and secure place, or destroyed in a secure manner.

Page 4 of 4

"Application for Horse Racing Licence and Registration" - British Columbia, Canada

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