Offence Declaration (Form 3038E) Who is your Child Care Advisor? *Please select your Child Care Advisor...ClairHediKatyeMargaretMeganSandraI don't knowIf you are unsure, please select 'I don't know'.Please Select: *I am a Child Care ProviderI live with a Child Care ProviderName of Child Care Provider1. Instructions This form is intended for use by child care programs licensed under the Child Care and Early Years Act, 2014, to meet the following requirements: Licensees must obtain offence declarations from all individuals from whom they have previously obtained a vulnerable sector check. The offence declaration must be obtained in every calendar year, except a year in which a vulnerable sector check is obtained, and dated no later than 15 days after the anniversary date of the most recent offence declaration or vulnerable sector check. Licensees must obtain a statement from any person who turns 18 years old while in a position where he or she interacts with children receiving care, within one month after the person turns 18 years old. The statement must disclose every previous finding of guilt of the person under the Youth Criminal Justice Act (Canada), if the person received an adult sentence. Where a licensee has accepted a copy of a vulnerable sector check from a volunteer or student, instead of the original documents, the volunteer or student must provide an offence declaration that addresses the period since day the vulnerable sector check was performed if more than six months but less than five years have passed since the day the vulnerable sector check was performed. Any person from whom a licensee is required to obtain a vulnerable sector check is required to provide the licensee with an offence declaration, as soon as reasonably possible, any time he or she is convicted of an offence under the Criminal Code (Canada). This form must be completed and signed by the individual from whom an offence declaration is required. The form must also be signed by the licensee or designate to confirm receipt. This form must be retained for ministry review. 2. DeclarationFirst Name *Last Name *Date of last vulnerable sector check, or last offence declaration, whichever is most recent, or date of 18th birthday Likely January 2020. If unsure, please leave blank.Check all that apply *I have not been convicted of an offence under section 151 (sexual interference) of the Criminal Code (Canada).I have not been convicted of an offence under section 163.1 (child pornography) of the Criminal Code (Canada).I have not been convicted of an offence under section 215 (duty of persons to provide necessaries) of the Criminal Code (Canada).I have not been convicted of an offence under section 229 (murder) of the Criminal Code (Canada).I have not been convicted of an offence under section 233 (infanticide) of the Criminal Code (Canada).I have been convicted of the following offences under the Criminal Code (Canada): I declare that the above discloses all of my convictions under the Criminal Code (Canada) since the date specified above. In addition, I am aware of my duty to provide the licensee of the child care centre or home child care agency, as the case may be, with an offence declaration as soon as reasonably possible at any time that I am convicted of an offence under the Criminal Code (Canada). Signature *Start signing your signature hereYour browser does not support e-Signature field.Date: *SubmitPlease do not fill in this field.