Police Constable(s)

Cape Breton Regional Police are seeking aspiring and experienced Police Constables to work in the
second largest municipal force in the province, with a well-earned reputation as an innovative and
progressive police service. In this full-service agency, you will have the opportunity to work in 20 different
specialized sections and teams in meaningful and satisfying work to ensure public safety and stay
connected to our communities.

The Cape Breton Regional Municipality officers a competitive compensation and benefits package:

• $62,000 - $113,000 (as of 2026 dependent on years of service)
• Promotional opportunities
• Salary equal to years of service for Experienced Officers
• Medical, Dental, Vision, Extended Health, Group Insurance, EFAP, etc.
• Nova Scotia Public Service Superannuation Plan
• $10,000 hiring incentive for Experienced Officers
• Paid on-the-job training for cadets selected through our Atlantic Police Academy sponsorship upon
signing a 2-year service agreement.
• Further information is available in the collective agreement

Plus, you will enjoy a quality lifestyle on award-winning Cape Breton Island with short commute times,
communication connection, public confidence, and trust in your service.

If you are considering a career in policing, CBRPS and the Atlantic Police Academy (APA) have
partnered together to offer placements in their bi-annual classes starting in January and July.
• For information on the Police Science Program through Holland College, please click here.
• To connect with a member of Holland College, please click here.

To connect with a member of the CBRM Recruiting Team, please click here.

For an insider look at CBRPS – check out this video: “Shape Your Career with the CBRPS”

Applications may be submitted to: Application Deadline:

In-person or Drop-box:

Cape Breton Regional Municipality
Attn: Human Resources Department This posting shall remain open until all vacancies
320 Esplanade, Sydney, N.S. B1P7B9 are filled.

Fax: 902-563-5582

Email: [email protected]

Guided by Employment Equity principles, we encourage applications from members of designated groups, including but not
limited to Indigenous peoples, people of African descent, other racially visible persons, persons with disabilities, women in
underrepresented occupations or positions, and members of the 2SLGBTQIA+ communities.
POLICE CONSTABLE HIRING INFORMATION
There are two pathways to employment:

1. Experienced officers or those who've graduated with an accredited Police Science Certificate.

2. Individuals interested in attending the Atlantic Police Academy through sponsorship by CBRPS.

If interested, please:
a. Ensure you meet minimum qualifications on pages 4 & 5 of the CBRPS application.
b. Complete the CBRPS application and provide the necessary documentation listed on
pages 4 & 5 and submit as directed on page 1.

A member of the HR Team will connect with you once reviewed.

Hiring Phases:

Upon submission, your application will be screened – if selected to proceed, a brief look at what you can
expect from the selection process is listed below:

Experienced Officers Atlantic Police Academy Sponsorship
APA – Phase 1
• Police Officer Selection Test (POST)
CBRM • Polygraph interview
• Interview • Minnesota Multiphase Personality
• Enhanced security screening Inventory (MMPI)
o and/or Pre-employment polygraph • More Information here
questionnaire and interview.
• Psychological Evaluation CBRM – Phase 2
• Medical Assessment • Medical Assessment
• Background Check • Background Check
• Credit History Check • Credit History Check
• Reference Checks • Reference Checks
• Drug & Alcohol Screening • Drug & Alcohol Screening
• Interview (after on-the-job training)

If partaking in the CBRPS & APA Sponsorship, successful graduation from the Police Science (Cadet)
Program, including your on-the-job training with CBRM, is a minimum requirement.

The Cape Breton Regional Police Service, in partnership with the people,
is committed to serve and protect our community.
www.cbrps.ca
Experienced Police Officers are encouraged to apply. CBRPS does not practice a lateral entry
process. Successful candidates will not retain their previous rank, compensation, or seniority. Prior
service may be recognized when determining starting salary.

NOTICES & INSTRUCTIONS
1. An essential part in the selection process of the Cape Breton Regional Police Service is background
investigation. Information gathered will be used to assess the suitability of the applicant for a police
career. There will be a security check on the applicant and members of their family.

2. The applicant must answer all questions. If a question is not applicable, mark N/A and attach a note
explaining the reason any question is left blank.

3. All information supplied is subject to verification by investigation. False statements can disqualify or
result in dismissal if employed.

4. Complete this form by printing in ink. Neatness and legibility are of the utmost importance.
Applications may be completed electronically as directed or requested.

5. If extra space is required, attach additional pages to this application.

6. Postal codes must be supplied for each address given.

7. No information received from inquiries concerning information in this application will be released to
the applicant.

Guided by Employment Equity principles, we encourage applications from members of designated
groups, including but not limited to Indigenous peoples, people of African descent, other racially
visible persons, persons with disabilities, women in underrepresented occupations or positions,
and members of the 2SLGBTQIA+ communities.

The Cape Breton Regional Police Service, in partnership with the people,
is committed to serve and protect our community.
www.cbrps.ca
MINIMUM QUALIFICATIONS CHECKLIST
All items listed below must be submitted along with this package.

 Proof of Canadian Citizenship or permanent resident status. Must be 19 years of age when starting
the program.
o For example, a birth certificate, passport, permanent resident card, etc.

 Proof of graduation from the Atlantic Police Academy or an equivalent Police Training facility (or see
next checkbox)
o If partaking in the CBRPS & APA Sponsorship, successful graduation from the Police Science
Program, including your on-the-job training with CBRM, is also a minimum requirement.

 Five (5) years uninterrupted recent experience with an accredited Canadian police agency.
o All former graduates from the Atlantic Police Academy or equivalent Police Training Facility
may be considered.
o Experienced Police Officers are encouraged to apply. The CBRPS does not practice a
lateral entry process. Successful candidates will not retain their previous rank, compensation,
or seniority. Prior service may be recognized when determining starting salary.

 CBRM Pare Medical Clearance Form (Part 1 & 2)
o Must be completed by a physician.
o Form is included in the application package. Candidates must be medically fit to be accepted
into the program.

 Physical Abilities Readiness Examination (PARE)
o PARE tests are valid for 6 months.
o An official certificate must be provided upon completion.
o Applicants unable to locate testing may request assistance through Human Resources

 Visual Examination Form
o Included within this package – valid for 2 years.

 Hearing Examination Form
o Included within this package – valid for 1 year.

 CBRM Medical Examination of Fitness for Work Form
o Included within this package.

 Criminal Record Check and Vulnerable Sector Check
o Applicants who have been found guilty of and/or convicted of a criminal offence must have
received an absolute discharge or a pardon. Candidates must submit to a criminal record

The Cape Breton Regional Police Service, in partnership with the people,
is committed to serve and protect our community.
www.cbrps.ca
check and vulnerable sector check from their local police service and sign the criminal
consent form giving permission for a background check.

 Copy of Valid Unrestricted Canadian Driver’s License (front and back)
o Must possess and maintain a valid Canadian driver’s license.

 Copy of Driver’s Abstract
o Must be processed in last 6-months.
o Must indicate an acceptable driving record for last three years.

 Copy of current Intermediate Workplace First Aid, CPR Level C & AED.
o This must be taken in-person and not on-line.

 Three (3) letters of reference – one must be work-related.

 Copy of your highest level of completed education. At minimum, you must have completed High
School or equivalent.
o Partially completed post-secondary education may warrant a waiver for the Police Officer
Suitability Test required by Holland College. Transcripts must be submitted for review and
determination.

Please Note:

If you are selected to proceed in our hiring process, you will also be required to complete bloodwork,
urinalysis and an EKG.

Forms to have these tests completed will be provided by Human Resources at a later date.

These tests alongside your CBRM fit-to-work form, hearing and vision examination forms will be provided
to our contacted physician to complete the medical assessment portion of the selection process.

The medical assessment is coordinated through Human Resources and is not to be scheduled by
the candidate with a primary physician unless directed to do so.

The Cape Breton Regional Police Service, in partnership with the people,
is committed to serve and protect our community.
www.cbrps.ca
LAST NAME GIVEN NAME MIDDLE NAME

FULL ADDRESS CITY PROVINCE POSTAL CODE

EMAIL ADDRESS TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) TELEPHONE NO. (OTHER)

[ ] [ ] [ ]

Other than the name(s) listed above, please list any name change(s), or name(s) you may have used in the past.

NAME CHANGE FROM: NAME CHANGE TO:
Date of Change:

PROVINCE CLASS(ES) LICENCE NUMBER
DRIVER’S Date of Issue:
LICENCE
EDUCATION AND TRAINING P roof of education w ill be required prior to engagem ent

HIGH Circle highest grade
NAME OF SCHOOL LOCATION

SCHOOL com pleted HIGH SCHOOL DIPLOMA
10 11 12 13 EQUIVALENCY DIPLOMA
COLLEGE, BUSINESS NAME OF SCHOOL LOCATION

SCHOOL, OR TECHNICAL
SCHOOL
START DATE FINISH DATE
PROGRAM OR COURSE
YYYY MM YYYY MM

LENGTH OF GRADE POINT AVERAGE CERTIFICATE DIPLOMA LICENCE AWARDED? (I F NOT – P LEASE P ROVI DE DETAI LS)
COURSE

NO
COLLEGE, SCHOOL NAME OF SCHOOL LOCATION

SCHOOL, OR BUSINESS
TECHNICAL
START DATE FINISH DATE
PROGRAM OR COURSE
YYYY MM YYYY MM

LENGTH OF GRADE POINT AVERAGE CERTIFICATE DIPLOMA LICENCE AWARDED? (I F NOT – PLEASE P ROVI DE DETAI LS)
COURSE
NO
NAME OF SCHOOL LOCATION
UNIVERSITY
PROGRAM OR COURSE START DATE FINISH DATE
YYYY MM YYYY MM

MAJOR/MINOR

LENGTH OF GRADEPOINT AVERAGE CERTIFICATE DIPLOMA DEGREE AWARDED? (I F N OT – P LEASE P ROVI DE DETAI LS)
COURSE
NO
NAME OF SCHOOL LOCATION
UNIVERSITY
START FINISH DATE
PROGRAM OR COURSE
YYYY DATEMM YYYY MM

MAJOR/MINOR

LENGTH OF GRADEPOINT AVERAGE CERTIFICATE DIPLOMA DEGREE AWARDED? (I F NOT – P LEASE P ROVI DE DETAI LS)
COURSE
NO
NAME OF SCHOOL LOCATION
UNIVERSITY
PROGRAM OR COURSE START FINISH DATE
YYYY DATEMM YYYY MM

MAJOR/MINOR

LENGTH OF GRADEPOINT AVERAGE CERTIFICATE DIPLOMA DEGREE AWARDED? (I F NOT – P LEASE P ROVI DE DETAI LS)
COURSE
NO

The CBRM is committed to the principles of Employment Equity and encourages applications from the designated groups; women, visible
minorities, aboriginals and persons with disabilities. CBRM encourages the need for respect, integrity, diversity, accountability and the
public good.

Sex: M_____ F ______ O ______

Self-Identity:
Are you a member of an under represented group? Yes or No
Do you require a workplace accommodation? Yes or No

LANGUAGES SPOKEN

LANGUAGES WRITTEN
ADDITIONAL EDUCATION INCLUDING COURSES, WORKSHOPS, AND SEMINARS. (ATTACH AN ADDITIONAL PAPER IF NECESSARY)

ADDITIONAL COMPUTER SKILLS, TRAINING, COURSES, ETC ... (ATTACH AN ADDITIONAL PAPER IF NECESSARY)

HAVE YOU EVER APPLIED FOR A POSITION WITH THIS OR ANY OTHER POLICE AGENCY? YES (if YES – W here & W hen) OR NO

LIST ALL APPLICATIONS TO THIS OR ANY OTHER POLICE AGENCIES
APPLICATION DATE
POLICE AGENCY STATUS (describe reason for non-selection)
YYYY MM DD

HAVE YOU EVER TAKEN A POLYGRAPH EXAMINATION? YES or NO
YYYY MM DD
AGENCY WHERE POLYGRAPH EXAMINATION WAS COMPLETED

REASON FOR POLYGRAPH EXAMINATION

HAVE YOU EVER BEEN FINGERPRINTED? YES or NO

REASON FOR FINGERPRINTING
Begin w ith your m ost recent em ployer and continue in reverse tim e order.
P rovide history for the last ten (10) years if applicable.
EMPLOYMENT HISTORY P rovide an ex planation for all gaps in em ploym ent.
P lease note that a typew ritten resume w ill also be required at a point during the selection
process.

MOST EMPLOYER’S NAME TELEPHONE NUMBER

RECENT [ ]
EMPLOYER’S ADDRESS POSTAL CODE

NAME OF IMMEDIATE SUPERVISOR TELEPHONE NUMBER

[ ]
START DATE FINISH DATE POSITION HELD
YYYY MM YYYY MM

DUTIES/RESPONSIBILITIES

REASON FOR LEAVING

EMPLOYER’S NAME TELEPHONE NUMBER
2nd [ ]
EMPLOYER’S ADDRESS POSTAL CODE

NAME OF IMMEDIATE SUPERVISOR TELEPHONE NUMBER

[ ]
START DATE FINISH DATE POSITION HELD
YYYY MM YYYY MM

DUTIES/RESPONSIBILITIES

REASON FOR LEAVING

EMPLOYER’S NAME TELEPHONE NUMBER
3rd [ ]
EMPLOYER’S ADDRESS POSTAL CODE

NAME OF IMMEDIATE SUPERVISOR TELEPHONE NUMBER

[ ]
START DATE FINISH DATE POSITION HELD
YYYY MM YYYY MM

DUTIES/RESPONSIBILITIES

REASON FOR LEAVING
EMPLOYMENT HISTORY (Continued)

EMPLOYER’S NAME TELEPHONE NUMBER
4th [ ]
EMPLOYER’S ADDRESS POSTAL CODE

NAME OF IMMEDIATE SUPERVISOR TELEPHONE NUMBER

[ ]
START DATE FINISH DATE POSITION HELD
YYYY MM YYYY MM

DUTIES/RESPONSIBILITIES

REASON FOR LEAVING

EMPLOYER’S NAME TELEPHONE NUMBER
5th [ ]
EMPLOYER’S ADDRESS POSTAL CODE

NAME OF IMMEDIATE SUPERVISOR TELEPHONE NUMBER

[ ]
START DATE FINISH DATE POSITION HELD
YYYY MM YYYY MM

DUTIES/RESPONSIBILITIES

REASON FOR LEAVING

IF YOU WERE ASKED TO RESIGN, OR WERE FIRED FROM A JOB, OR HAD A GAP IN EMPLOYMENT, PLEASE PROVIDE DETAILS
AND EXPLANATIONS.
CREDIT HISTORY Please complete the following information.

NAME

MAIDEN NAME / OTHER NAMES USED Social Insurance Number

DATE OF BIRTH EMPLOYER’S NAME
YYYY MM DD

CURRENT ADDRESS FROM TO
YYYY MM DD YYYY MM DD

CITY PROVINCE COUNTRY POSTAL CODE

PREVIOUS ADDRESS FROM TO
YYYY MM DD YYYY MM DD

CITY PROVINCE COUNTRY POSTAL CODE

PREVIOUS ADDRESS FROM TO
YYYY MM DD YYYY MM DD

CITY PROVINCE COUNTRY POSTAL CODE

PREVIOUS ADDRESS FROM TO
YYYY MM DD YYYY MM DD

CITY PROVINCE COUNTRY POSTAL CODE

PROVINCE CLASS(ES) LICENCE NUMBER DATE OF ISSUE:
DRIVER’S
LICENCE
TYPE ISSUING INSTITUTION CURRENT BALANCE OWING EXPIRATION DATE
CREDIT YYYY MM

CARDS
TYPE ISSUING INSTITUTION CURRENT BALANCE OWING EXPIRATION DATE
YYYY MM
2
TYPE ISSUING INSTITUTION CURRENT BALANCE OWING EXPIRATION DATE
YYYY MM
3
TYPE ISSUING INSTITUTION CURRENT BALANCE OWING EXPIRATION DATE
YYYY MM
4

OFFICE USE ONLY

FILE MANAGER

DATE SENT (Fax)
YYYY MM DD DATE RECEIVED (Fax) YYYY MM DD
FILE
SECURITY CLEARANCE DECLARATION MANAGER
OFFICE USE ON LY

This page contains detailed information regarding you, your family, and associates.
This information is required to determine your eligibility for employment.
THIS INFORMATION WILL BE HELD IN STRICTEST CONFIDENCE.
Please print legibly. Ensure that all sections are completed. Additional sheets should follow suggested format.
LAST NAME FIRST NAME MIDDLE NAME PREFERRED FIRST NAME

MAIDEN / OTHER NAMES USED

FULL ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
DATE OF BIRTH SEX PLACE OF BIRTH
YYYY MM DD

 Male  Female  Other
MARITAL STATUS

 Single  Married  Common-law / Domestic Partner  Separated  Divorced

If you checked married, common-law or domestic partner, please give full name and date of birth and Social Insurance Number of your partner.
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME DATE OF BIRTH
YYYY MM DD

SOCIAL INSURANCE NUMBER

HAVE YOU APPLIED FOR EMPLOYMENT/CONTRACT WORK/VOLUNTEER WORK WITH ANY POLICE SERVICE IN THE PAST?

 YES  NO
POSITION APPLIED FOR DIVISION / SECTION

IN CHRONOLOGICAL ORDER, MOST RECENT FIRST, PLEASE PROVIDE THE ADDRESSES OF EVERY LOCATION WHERE YOU HAVE LIVED IN
THE LAST 10 YEARS, AND THE NAMES OF PERSONS WHO LIVED WITH YOU. PLEASE ESTIMATE THE AGE IF THE EXACT DATE(S) OF BIRTH
CANNOT BE OBTAINED. USE NEXT PAGE OR ATTACH ADDITIONAL SHEETS IF REQUIRED.
ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM DD YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX
NAME OF PERSON(S) WHO SHARE ADDRESS WITH YOU DATE OF BIRTH

[ ] YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
YYYY MM DD
[ ]
RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
SEX
ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX
NAME OF PERSON(S) WHO SHARED ADDRESS WITH YOU DATE OF BIRTH

[ ] YYYY MM DD

RELATIONSHIP SEX DATE OF BIRTH
TELEPHONE NUMBER
YYYY MM DD
[ ]
RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
SECURI TY CEARAN CE DECLARATI ON
(Continued)
Attach an additional sheet(s) if required – follow ing the suggested form at.

ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM DD YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
NAME OF PERSON(S) WHO SHARED ADDRESS WITH YOU

[ ] YYYY MM DD

RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
YYYY MM DD
[ ]
ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM DD YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
NAME OF PERSON(S) WHO SHARED ADDRESS WITH YOU

[ ] YYYY MM DD

RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM DD YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
NAME OF PERSON(S) WHO SHARED ADDRESS WITH YOU

[ ] YYYY MM DD

RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
YYYY MM DD
[ ]
ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM DD YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
NAME OF PERSON(S) WHO SHARED ADDRESS WITH YOU

[ ] YYYY MM DD

RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
TELEPHONE NUMBER RELATIONSHIP SEX DATE OF BIRTH
YYYY MM DD
[ ]
ADDRESS CITY PROVINCE POSTAL CODE FROM TO
YYYY MM DD YYYY MM DD

TELEPHONE NUMBER RELATIONSHIP SEX
NAME OF PERSON(S) WHO SHARED ADDRESS WITH YOU DATE OF BIRTH
[ ] YYYY MM DD

RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM DD
[ ]
RELATIONSHIP SEX
TELEPHONE NUMBER DATE OF BIRTH
YYYY MM
[ ] DD
SECURI TY CLEARANCE DECLARATI ON
FAMILY MEMBERS (Continued)
Attach an additional sheet(s) if required – follow ing the suggested form at.

Applicants must list all names, relationship, date of birth, address and phone number of their *immediate relatives
AND of the immediate relatives of their current and/or former spouse, domestic partner, common-law, or significant
other.

• *Immediate relatives include parents, stepparents, guardians, current and/or former spouse, domestic partner,
common-law, or significant other, as well as children, stepchildren, adopted children, brothers, sisters, step-
brothers/sisters, adopted brothers/sisters, age 12 or over. This includes persons who are deceased.

SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX
ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX TELEPHONE NUMBER
ADDRESS CITY PROVINCE POSTAL CODE

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX TELEPHONE NUMBER
ADDRESS CITY PROVINCE POSTAL CODE

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX TELEPHONE NUMBER
ADDRESS CITY PROVINCE POSTAL CODE

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX TELEPHONE NUMBER
ADDRESS CITY PROVINCE POSTAL CODE

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX TELEPHONE NUMBER
ADDRESS CITY PROVINCE POSTAL CODE

[ ]
S E C U R I TY C L E A R A N C E D E C L A R A TI O N
FAMILY MEMBERS (Co nt inu ed)
A tt ach an addit ional sheet (s) if requ ired – follow in g th e suggested form at .

SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATEOFBIRTH
YYYY MM DD

RELATIONSHIP SEX TELEPHONE NUMBER
ADDRESS CITY PROVINCE POSTAL CODE

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SURNAME / MAIDEN NAME / OTHER NAMES USED FIRST NAME MIDDLE NAME COMMON NAME USED DATE OF BIRTH
YYYY MM DD

RELATIONSHIP SEX ADDRESS CITY PROVINCE POSTAL CODE TELEPHONE NUMBER

[ ]
SECURI TY CLEARANCE DECLARATI ON
(Continued)
Attach an additional sheet(s) if required – follow ing the suggested form at.

1. Have you ever been convicted of any criminal offence in Canada or in any other country for o YES
which a pardon, or the equivalent of a pardon was or was not granted? (Attach Pardon Document) o NO

2. Are you now, or have you ever been investigated, arrested, or charged in Canada or in any o YES
other country for an offence of any kind? If yes – explain on separate sheet. o NO

3. Have you ever been found guilty of an offence in Canada or in any other country when you o YES
were under the age of 18? If yes – explain on separate sheet. o NO

4. Are you associated with any companies, or businesses, not listed on your application? o YES
o Owner o Director o Controlling Share Holder o Other o NO

5. Are you a member of any clubs or organizations? o YES
If yes – explain which o NO

6. If you answered yes to the previous question, do you hold a position in that club or organization?
o YES
o President o Chair o Director o Other o NO

7. In the past 10 years, have you been involved in any lawsuits or civil actions?
o YES
o NO

If you have answered “YES” to any of the above questions, attach an additional sheet providing complete details regarding
the specific incident, including what occurred, when, where, and why. If pardoned, attach Pardon documentation.

STATEMENT OF CONSENT

I HEREBY CONSENT THAT any and all information pertaining to a Criminal Record registered in my name with the National
Repository for Criminal Records in Canada may be provided to authorized persons at the Cape Breton Regional Police Service
(CBRPS). I recognize that an employee of the CBRPS is in a position of trust within the community and I hereby consent to the
CBRPS performing a VS (Vulnerable Sector) search of my name in the National Repository for Criminal Records. I understand that
a VS search is a search that will check for pardoned sex offences. I further consent, if requested, to attend the Identification
Section of the CBRPS for fingerprint confirmation. I further agree to absolutely release, discharge, and absolve the CBRPS, the
Cape Breton Regional Municipality and its employees from all claims, losses, or damages including indirect or consequential,
occasioned by me during, or as a result of any investigation for a Criminal Record.

Dated this______day of , 20______
SIGNATURE

PRINTED NAME OF WITNESS WITNESS SIGNATURE
P lease list eight (8) adults (3 m ust be close personal friends, not related to
you, and not previous em ployers, w ho w e m ay contact as references to provide
com petent judgm ent of your personal character, tem peram ent, and w ork
REFERENCES habits.
(P lease note that at any point during the selection process three (3) letters of reference of w hich
one must be a w ork reference, , w ill also be required in addition to those listed below )
LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
[ ] [ ]
LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
[ ] [ ]
LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
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LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
[ ] [ ]
LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
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LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
[ ] [ ]
LAST NAME GIVEN RELATIONS
NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
[ ] [ ]
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NAMES HIP

FULL ADDRESS POSTAL
CODE

TELEPHONE NO. (RES.) TELEPHONE NO. (BUS.) OCCUPA YEARS
TION KNOWN
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Cape Breton Regional Police Service
Applicant Vision Examination Report

Applicant Information
To be completed by the applicant

Surname Given Names Date of Birth (yyyy-mm-dd)

Street Address City Province Postal Code (A9A 9A9) Date of Exam (yyyy-mm-dd)

VisualExamination
Visual Examination
To be completed by the Ophthalmologist or Optometrist

Visual Acuity
Any standardized procedures (Landoit Ring, Snellen) may be utilized. No error is allowed per line of symbols.
Uncorrected Right Eye (6/ or 20/) Yes No Uncorrected Left Eye (6/ or 20/)

Corrected Right Eye (6/ or 20/) Corrected Left Eye (6/ or 20/)
Corrected by
Eyeglasses Contact Lenses
Vision Standards Visual Acuity
 Corrected vision (with glasses or contacts): Visual acuity must be at least 6/6 (20/20) in one eye and 6/9 (20/30) in the other; and
 Uncorrected vision (without glasses or contacts): Visual acuity must be at least 6/18 (20/60) in each eye or 6/12 (20/40) in one eye and at least 6/30
(20/100) in the other eye.

Meets Standards, both corrected and uncorrected?
Yes No
Visual Fields
Field of Vision Standards
Must be at least 150 degrees continuous along the horizontal meridian and 20 degrees continuous above and below fixation, with both eyes open
and examined together.
Meets Standards?
Yes No
Colour-Vision
Standardized Ishihara pseudo-isochromatic plates must be utilized. Testing is to be done without the candidate using any colour correcting aids, such
as coloured contact lenses.

a) Result of standardized Ishihara pseudo-isochromatic plates test
Passed Failed. If so, re-test using Farnsworth D-15.
b) Result of Farnsworth D-15 test (if the applicant failed the plate test). Attach the results.
Passed Failed
Colour-Vision Testing Standards
 Using the standardized Ishihara pseudo-isochromatic plates, if at least 17 of 21 patterns are correctly identified (pass) colour-vision will be considered
normal;
 If required, further evaluation will be conducted with the Farnsworth D-15 test. If the applicant passes the Farnsworth D-15 test, the applicant will be
considered to meet the minimum colour-vision standards; and
 If the applicant fails both the Ishihara test and the Farnsworth D-15 test, the minimum vision standards for an CBRPS applicant are not met.
Meets Standards?
Yes No
Ocular Disease / Conditions
Applicant must be free from ocular diseases impairing visual performance. If there is a history or the presence of an ocular disease, further information may be
required at the medical examination stage for individual assessment.
Is there any indication of the presence of the following
Strabismus Diplopia Eye Disease specify:
Is there any indication that the applicant could be at risk of experiencing double vision when tired or in an environment with reduced visual cues and/or
greater visual strain and/or stress?
Yes No

Page 1 of 2
Applicant Vision Examination Report
Any other testing performed? Yes No
If other testing performed, clarifiy including test and result:
Refractive Surgery, including Corneal and Intra-Ocular Lens Procedures
Has the applicant had refraction correction surgery?
Yes No
If the applicant had refraction correction surgery, please identify the type
LASIK PRK Implanted Corrective Lenses (ICL, PIOL) Other specify:
Date of Surgery (yyyy-mm-dd)

Standard Post-Refractive Correction Surgery - Applicant must wait the following time before having a vision examination completed
 Laser-assisted in-situ keratomileusis (LASIK) surgery - thirty (30) days;
 Photorefractive keratectomy (PRK) surgery - ninety (90) days;
 Implanted corrective lenses (ICL, PIOL) surgery with anterior chamber lens - six (6) months; and
 Implanted corrective lenses (ICL, PIOL) surgery with posterior chamber lens - twelve (12) months.

Does the applicant have any history of
Halos Starbursts Night Vision Difficulties Contrast Sensitivity Difficulties
Is the applicant's vision now stable? Is there currently any increased risk, relative to "normal" eyes, for damage to the eyes upon physical confrontation?
Yes No Yes No
Specify any other acute or chronic problems with the function of the eyes or adnexa, if applicable.

Declaration, Acknowledgement and Consent
To be completed by the applicant
I declare that the statements made to the Ophthalmologist/Optometrist are complete and correct to the best of my knowledge and that I have not
withheld any relevant information or made any misleading statements.

I acknowledge that incomplete forms will be returned to my attention and may result in disqualification of my application.
I acknowledge that my vision examination report is valid for two (2) years from the testing date.
I acknowledge that the cost of this examination, refractive correction surgery, and reports prepared by the Ophthalmologist or optometrist are my
responsibility.
I consent that this information be provided to CBRM for pre-selection purposes.
I consent to CBRM contacting the ophthalmologist or optometrist indicated below if clarification of this vision examination is required.

_________________________ _____________________
Signature Date (yyyy-mm-dd)

Ophthalmologist or Optometrist
To be completed by the Ophthalmologist or Optometrist

Surname First Name Specialty Licence Number
Ophthalmologist Optometrist
Business Address Telephone No. (incl. area code)

________________________________________________________________
Signature Date (yyyy-mm-dd)

Page 2 of 2
HEARING
REPORT
Please ensure all areas are fully completed.

SURNAME GIVEN NAMES INITIAL
NAME OF APPLICANT
ADDRESS OF APPLICANT

CITY PROVINCE POSTAL CODE DATE OF BIRTH
YYYY M M D D

HEARING STANDARDS FOR POLICE OFFICER APPLICANTS
NAME OF AUDIOLOGIST: DATE OF EXAMINATION
AUDIOLOGIST YYYY MM DD

ADDRESS OF AUDIOLOGIST:

TELEPHONE NUMBER

[ ]

PURE TONE
THRESHOLDS 250 500 1000 2000 3000 4000 6000 8000
IN HZ

RIGHT EAR

LEFT EAR

Hearing Requirements:
a) Hearing Loss no greater than 30 dbs in both ears in the 500 to 6,000 Hz frequency range.
b) Hearing loss no greater than 30 dbs in the better ear in the 500 to 3000 Hz frequency range;
c) Hearing loss no greater than 30 dbs in the worst ear in the 500 to 2900 Hz frequency range, and no
more than 50 dbs in the worst ear at 3000 Hz frequency range.

I certify that the above named individual MEETS ____ DOES NOT MEET ____
the hearing requirements for a Police Officer applicant as indicated in above noted requirements.

SIGNATURE OF AUDIOLOGIST DATE
YYYY MM DD

SIGNATURE OF APPLICANT DATE
YYYY MM DD
CBRM Medical Examination of Fitness for Work

To be completed by Applicant.

Name: Date of Birth:

1. Family History 4. Medical History
Have any immediate blood relatives ever had: Do you or have you ever had or been treated for any of the
following medical conditions:
Yes No Yes No
1.1 Diabetes 4.1 Asthma, bronchitis, pneumonia, pleurisy,
1.2 Heart disease tuberculosis or other lung disease
1.3 High blood pressure 4.2 Disease of the nose or throat
1.4 Ulcers or bowel problems 4.3 Ear disease, loss of balance or dizziness
1.5 Mental illness 4.4 Hay fever, allergies or hives
1.6 Asthma 4.5 Rheumatic fever, heart disease or murmur
1.7 Epilepsy
1.8 Tuberculosis
1.9 Cancer 4.6 High blood pressure
1.10 Strokes 4.7 Chest pain, angina or palpitations
4.8 Varicose veins or phlebitis
2. Personal History 4.9 Bleeding tendency or bruising
4.10 Diabetes, thyroid disease or other glandular
2.1 Have you ever been refused employment or disease
life insurance because of your health?
2.2 Have you ever been regularly exposed to toxic
chemicals (such as solvents, asbestos etc.) or 4.11 Seizures, fainting or epilepsy
excessive noise levels? 4.12 Head injury or concussion
2.3 Have you any religious medical concerns that 4.13 Stroke or paralysis
might affect your health care 4.14 Severe recurrent headache or migraine
2.4 Do you smoke? 4.15 Loss of or impaired vision or eye disorder
How much per week?
2.5 Do you drink alcohol?
How much per week? 4.16 Psychosis, anxiety, depression or other mental
2.6 Have you ever had any medical problems due illness
to mind-altering street or addictive drugs? 4.17 Stomach, duodenal or peptic ulcer
2.7 Have you been off work in the past year 4.18 Gall bladder disease, jaundice or hepatitis
because of illness or injury? 4.19 Diarrhea or bowel disease
2.8 Have you ever had any broken bones, back 4.20 Kidney disease, kidney stones or bladder
Injuries, neck injuries, or shoulder injuries disease
2.9 Do you suffer from any phobias?
2.10 If so, does this concern:
flying 4.21 Sexually-transmitted disease
confined spaces 4.22 Skin diseases, rashes, eczema or dermatitis
fire 4.23 Bone or joint disease or injury
water 4.25 Tropical disease, malaria, dysentery etc.
heights 4.26 Cancer, tumour or growths
other
2.11 Do you participate in a regular exercise
program? 4.27 Other operations, serious illnesses or injuries
2.12 Do you drink coffee, tea or cola? 4.28 (Women) Gynecological disease
2.13 Have you ever received WCB benefits? 4.29 Motion sickness
2.14 Have you ever received long term disability 4.30 Dental disease, toothache
benefits (LTD)? 4.31 Weight gain or loss over 10 lbs. in the last year
4.32 Date of last tetanus shot _________________
3. Medications
3.1 Do you take any medications?
3.2 Are you allergic to or have you ever had an
adverse reaction to any medications?
Remarks: Give details of any “yes” answers in sections 1-4.

Applicant's Declaration

I, (name) ____________________________________________ of

(address) ____________________________________________
declare that the above statements made by me for the purposes of my medical examination are true and complete. I understand that
any false statements shall be considered sufficient grounds to disqualify me from employment.
I also understand that this information will be treated as medically confidential and will not be forwarded to non-medical personnel.
Results only (i.e. "fitness to work") will be forwarded to hiring unit.

Signed: Date:
CBRM Pare Medical Clearance Form – To be completed by Physician

Dear Physician,

Subject: Medical Clearance to Undergo the Physical Abilities Requirement Evaluation

The person who has made this appointment with you is seeking medical clearance to undergo the Physical Abilities
Requirement Evaluation (PARE) as part of their application to become a Cape Breton Regional Police Officer.

PARE is an occupational physical abilities test used to assess a person’s ability to perform physical demands of police work. It
is a maximal exertion test equivalent to an exercise stress test at the 12 MET level.

PARE represents a scenario where an officer must get to the scene of a problem, physically control the situation, and carry a
person or an object away from the scene. The test is divided into the following three stations:

1. An obstacle course - 400 m long, including obstacles and stairs.

2. A push/pull station - which requires managing a 37 kg (80 lbs.) weight; completing six 180-degree arcs while
pushing; performing four controlled falls; and completing six 180 degree arcs while pulling.

3. A weightlifting and carrying station - which requires lifting and carrying a 45 kg (100 lbs.) bag over a distance of 15
m (50 ft.).

The first two sections (the obstacle course and the push/pull station) are timed. Applicants applying for the Cape Breton
Regional Police Service must complete these two sections in a time of 4:00 minutes or less.

Please complete, sign, date, and stamp the PARE medical clearance form. Please provide an original copy to patient and keep
a photocopy of the form on the patient's medical file. The original copy will be used as proof that the applicant has been
medically cleared to undergo the PARE.

Human Resources
Cape Breton Regional Municipality
PARE Medical Clearance - Part 1

Patient Information
Surname Given Name(s) Age

Gender Height (cm) Weight (kg) Resting Heart Rate Resting Blood Pressure
Female ___ Male ___ Other
Risk Factors MEI
Note to Physician
The Physical Abilities Requirement Evaluation (PARE) is a maximal physical exertion test equivalent to an exercise stress test at the 12 Metabolic Equivalent
for Task (MET) level. The following are risk factors to consider when assessing suitability for PARE.
Section A - For all Individuals - Pulmonary and Musculoskeletal Restrictions
If yes to any one risk factor in Section A, patient should not undertake PARE.
Pulmonary obstruction / restriction that would prevent maximal testing. Yes No
Needs to use a short acting inhaler immediately prior to participate in maximal testing. (Short acting inhalers can only be used
__ Yes ___ No
after the test if needed. Long acting or combined inhalers are allowed.)
Musculoskeletal restrictions that could interfere with strenuous activities or maximal testing. Yes No

Section B - For all Individuals - High or Very High Cardiovascular Risk Factors (ATP Ill I & CMAJ 2)
If yes to one or more risk factors in Section B, it is recommended to send the patient to an exercise stress test before clearing for PARE.
Previous CVA, MI, vascular surgery or any clinical evidence of atherosclerosis Yes No
Diabetes 3 Yes ____ No
Metabolic Syndrome Yes ____ No

Section C - For Men > Age 40 and Women > Age 50 - Coronary Artery Disease Risk Factors (ACSM 4 & CSEP 5)
If yes to two or more risk factors in Section C, it is recommended to send the patient for an exercise stress test before clearing for PARE.
Family history of premature cardiovascular disease Yes No
Cigarette smoking Yes No
Hypertension 6 Yes No
Dyslipidemia Yes No
Abnormal fasting glucose level Yes No
Obesity 7 Yes No
Physical inactivity Yes No

Section D - Exercise Stress Test (when required)
Clinically positive for ischemia No
Electrically positive for ischemia No
Number of MET reached (12 MET are required prior to undertaking PARE) Yes
Additional tests (if needed, specify)

Medical References

1) Detection, Evaluation and Treatment of High Blood Cholesterol in Adults. (Adult Treatment Panel Ill). National Institute of Health. National Heart, Lung and Blood Institute.
2) Recommendations for the Management of Dyslipidemia and the Prevention of Cardiovascular Disease: 2003 update. CMAJ appendix 2003; 168 (9) 921-924.
3) Report of the Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Diabetes Care. 2003; 26 (supp 1):S5-S20.
4) American College of Sports Medicine, Cited in ACSM Guidelines for Exercise Testing and Prescription, Seventh Edition. 2006.
5) Canadian Society of Exercise Physiology. Professional Fitness & Lifestyle Consultant. Resource Manual. 2004.
6) Canadian Recommendations for the Management of Hypertension (2005)
7) Canadian Guidelines for Body Weight Classification in Adults (2003)
PARE Medical Clearance - Part 2

Patient Information
Surname Given Name(s) Age

Gender Height (cm) Weight (kg) Resting Heart Rate Resting Blood Pressure
Female ___ Male ___ Other

Physician's Recommendations

After reviewing Part 1 of the PARE medical clearance and evaluating the following risk factors:
• Pulmonary Obstruction / Restriction
• Musculoskeletal Restrictions
• High or Very High Cardiovascular Risk Factors
• Coronary Artery Disease Risk Factors
• Exercise Stress Test to 12 MET, if applicable

it is my professional opinion that the above named patient is:
___ Medically fit to undertake the Physical Abilities Requirement Evaluation.
___ Not medically fit to undertake the Physical Abilities Requirement Evaluation.

Comments

Physician's stamp

Physician's signature Date (yyyy-mm-dd)
CAPE BRETON REGIONAL POLICE RECRUIT
SELECTION STANDARDS
AUTHORIZATION FOR RELEASE OF INFORMATION

SURNAME GIVEN NAMES INITIAL
NAME OF APPLICANT
ADDRESS OF APPLICANT

CITY PROVINCE POSTAL CODE DATE OF BIRTH
YYYY M M D D

I, _________________________________________ , the undersigned, hereby authorize any person,
employer, organization, or physician to provide any information, opinion, reports, records, documents
or copies thereof in any form, which may be requested in connection with my application for
employment with the Cape Breton Regional Police Service and any subsequent training.

Personal information about me will be used to assess my qualifications and suitability in relation to
my application as a police officer as well as research purposes. I consent to the collection, use,
disclosure, transmittal, and examination of all information compiled by the Cape Breton Regional
Police Service.

Personal information about me that is obtained during the selection process, or any subsequent
training and employment, may be disclosed to any law enforcement agency for the purpose for which
it was obtained or for any other reason.

I agree to waive any right of action against any person or organization providing information or
opinions in compliance with this authorization.

I hereby acknowledge and declare the terms of this authorization for release of information are fully
understood by me.

SIGNATURE OF APPLICANT: DATE:

SIGNATURES YYYY MM DD

NAME OF WITNESS: DATE:
SIGNATURE OF WITNESS:
YYYY MM DD

NOTE: The Witness must be 18 years or older