HTML version of the form: DND 6074, Adult Screening Application Form

Cadets and Junior Canadian Ranger Group Order (CJCR Gp O)

Warning

DND 6074-E - Adult Screening Application Form is categorized as "CAN PROTECTED B" information once completed.

In accordance with the National Defence Security Orders and Directives (NDSOD), Chapter 6: Security of Information and Standard 6: Security of Information Standards, DND and CAF information must be appropriately protected from unauthorized access, use, disclosure, modification, transmission, disposal or destruction throughout its lifecycle.

When completed, "CAN PROTECTED B" forms MUST NOT BE SAVED  on any network, workstation drive or storage media, and MUST BE ENCRYPTED USING THE DND ISSUED PKI SMARTCARD.

Failure to respect these requirements is a security incident that must be reported to the local ISSO, and may result in administrative or disciplinary measures.

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National Defence

CAN PROTECTED B (When completed)

Adult Screening Application Form

In order to fulfill the Canadian Armed Forces (CAF) legal obligations as responsible for youth, and to support volunteers properly, there is a need to ensure all adults are screened, registered and managed appropriately.

Along with this form, you will need to provide a photocopy of two pieces of government issued identification, one of which must include a photo, and a Vulnerable Sector Screening (VSS), which will include a Police Records Check (PRC). Details on how to acquire a VSS will be provided to you by your Canadian Ranger Patrol Group (CRPG).

Privacy Notice

In order to process your screening application, the CAF requires certain personal information from you. Only information needed for the purposes of determining your suitability to work with Junior Canadian Rangers (JCR) will be requested. All information collected during this process will be protected and kept confidential in accordance with The Privacy Act and National Defence Security Instruction 27, Classification and Designation of Information.

• Application Type:
  • Initial Application
  • Renewal
• Mark all necessary:
  • Volunteer
  • JCR Instructor
  • Reg F
  • DND Employee
  • Res F
  • Civilian contractor (pers)

Section 1: Personal Information

• Surname
• First Name
• Middle Name
• Date of Birth (yyyy-mm-dd)
• Maiden or Former Name(s)
• What is your gender?
  • Woman
  • Man
  • Gender diverse (optional to specify)
  • Prefer not to answer
• Address:
  • Street
  • City
  • Province/Territory
  • Country
  • Postal code
• Phone Number
• E-mail
• Employer (including address)
• Supervisor (including email)
• JCR Patrol Name
• UIC
• Primary Duties
• Do you have a child currently participating in the JCR Program?
  • Yes
  • No
    • If yes, provide JCR Patrol name:

Section 2: Previous / Current CAF and Cadet or JCR Experience

• Current CAF member
• Previous CAF service
• Previous experience as a Cadet or JCR
• No previous CAF, Cadet or JCR experience (if you checked this box, skip section 2)

Active / Previous CAF Personnel

• SN
• Rank (current or on release)
• Unit (current or on release)
• Unit CO (including email)
• Release Item
• Release Date (yyyy-mm-dd)
• MOSID

Previous Cadet or JCR Experience

• Years of Participation
• Element
• Corps / Squadron / Patrol Number
• Corps / Squadron / JCR Location
• Cadet or JCR Rank
• Staff Cadet or JCR Service Number (if known)

Section 3: References (cannot be a family member / related to you)

First Reference

• Name
• Relationship to you
• Phone Number
• E-mail

Second Reference

• Name
• Relationship to you
• Phone Number
• E-mail

Third Reference

• Name
• Relationship to you
• Phone Number
• E-mail

Section 4: Personal Declaration

• Have you ever been convicted of a criminal offence for which a pardon has not been granted?
  • Yes
  • No
• Do you have previous experience as a volunteer with a youth organization?
  • Yes
  • No
• I, the undersigned, agree that all information contained within this application is factual and been completed to the best of my ability. I permit the CAF, or its agents, to interview any of the references listed on my application. I also understand that the CAF reserves the right to accept or decline my services for any reason, except for those prohibited by the Canadian Charter of Rights and Freedoms. I understand that, if I am involved as a volunteer with the JCR Program, I will not be entitled to any remuneration and I recognize the safety and wellbeing of JCRs as my foremost responsibility. I hereby agree that I will immediately advise the CAF, after the signing of this form, should I commit an offence or be implicated in any type of activity that could change my status for my PRC or VSS.
• Date (yyyy-mm-dd)
• Signature

For Use by the CAF and/or designated agents only

• Minimum Age of 18
  • Suitable
  • Not Suitable
• Citizenship:
  • Canadian Citizen
  • Permanent Resident
  • Landed Immigrant Status
    • Suitable
    • Not Suitable
• Interview Completed - Date (yyyy-mm-dd):
  • Suitable
  • Not Suitable
• Current / Previous CAF Service Review (includes approval from current CO)
  • Suitable
  • Not Suitable
• First Reference - Date (yyyy-mm-dd):
  • Suitable
  • Not Suitable
• Second Reference - Date (yyyy-mm-dd):
  • Suitable
  • Not Suitable
• Third Reference (if required) - Date (yyyy-mm-dd):
  • Suitable
  • Not Suitable
• PRC/VSS - Date of Completion (yyyy-mm-dd):
  • Suitable
  • Not Suitable

Applicant Status

• Approved as:
  • Volunteer
  • JCRI
  • CAF member
• Not Approved

• Date (yyyy-mm-dd)
• Position
• Signature

DND 6074-F (06-2025) WCAG 2.0