BSF597 – Commercial Driver Registration Program Application

Protected B (when completed)

The information you provide in your application, including supporting documentation and biometric data, is collected by the Canada Border Services Agency ("CBSA") and is protected pursuant to both the Customs Act and the Privacy Act. In accordance with Canadian laws and regulations, this information will be shared with other government departments or agencies in Canada for the purpose of the operation of the Commercial Driver Registration Program ("CDRP") and to conduct applicable checks and verifications to determine your eligibility and continued eligibility in the CDRP. If the required information is not provided, your application may not be processed and the authorization may not be granted.

Individuals to whom the information relates have rights of access to, correction of, and protection of, their personal information under the Privacy Act. The information collected is described in Personal Information Bank # CCRA PPU 042. Instructions for obtaining information are provided in Info Source, which is available at public libraries, government public reading rooms and on the Internet at: http://infosource.gc.ca.

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Personal Information

• Preferred language (English/French)
• Application (New/Renewal)
• Border crossing(s) most frequently used
• If you participate in alternative methods of reporting to CBSA (e.g., CANPASS/NEXUS/FAST), please list program and membership numbers.
• Last (family) name
• Previous last (family) name(s) (if applicable)
• First name
• Middle name
• Nick name (if applicable)
• Date of birth YYYY-MM-DD
• Male/Female
• Country of birth
• Current Street address
  • City
  • Province or State
  • Postal code or Zip code
  • Country
• Telephone (home)
• Telephone (business) including extension and cellular number
• Fax
• E-mail

Mailing address (if different from above)

• Street address or P.O. box
• City
• Province or State
• Postal code or Zip code
• Country

• Driver's licence number and province or state
• Employer (Name and Address)
• I am a citizen of
  • Canada
  • the U.S.
  • Other (please specify)
• I am a permanent resident of Canada (Yes)
  • Landing date (if applicable) (YYYY-MM-DD)
• I am a permanent resident of the U.S. (Yes)
  • Permanent resident card number

Have you ever been found in violation of:

• any Canadian customs laws? (Yes/No)
• any Canadian immigration laws? (Yes/No)

Have you ever been convicted of a criminal offence for which a pardon has not been granted? (Yes/No)

Have you ever been convicted of an alcohol-related driving offence for which a pardon has not been granted? (Yes/No)

If you answered yes to any of these questions, please give details (add additional page if necessary). CBSA may ask for supporting documentation of disposition if required.

Privacy statement

The information you provide in your application, including supporting documentation, is collected by the Canada Border Services Agency ("CBSA") under the authority of the Customs Act and is protected pursuant to both the Customs Act and the Privacy Act. In accordance with Canadian laws and regulations, this information will be shared with other government departments or agencies in Canada for the purpose of the operation of the Commercial Driver Registration Program ("CDRP") and to conduct applicable checks and verifications to determine your eligibility and continued eligibility in the CDRP. If the required information is not provided, your application may not be processed and the authorization may not be granted.

Information collected for the purpose of the operation of the CDRP may be also be disclosed within the CBSA and to other government departments or agencies (including the Royal Canadian Mounted Police and the Canadian Security Intelligence Service) for their use, in accordance with section 107 of the Customs Act.

Individuals to whom the information relates have rights of access to, correction of, and protection of, their personal information under the Privacy Act. The collection, use, disclosure and retention of your personal information is described in Personal Information Bank # CCRA PPU 042. Instructions for obtaining information are provided in CBSA’s Information about Programs and Information Holdings (formely Info Source), which is available at public libraries, government public reading rooms and on the Internet at: https://www.cbsa-asfc.gc.ca/agency-agence/reports-rapports/pia-efvp/atip-aiprp/infosource-eng.html.

Individuals to whom the information relates also have the right to file a complaint to the Privacy Commissioner of Canada should they have a concern about how the CBSA handles their information. Instructions for filing a privacy complaint can be found at: https://www.priv.gc.ca/en/report-a-concern/file-a-formal-privacy-complaint/file-a-complaint-about-a-federal-institution/

Consent statement

I understand that any information gathered for the purposes of this application, including any supporting documentation, background information or biometric data, as well as information obtained from the relevant files of law enforcement agencies, including intelligence gathered for law enforcement purposes, will be used for the purpose of the operation of the CDRP and to conduct applicable checks and verifications to determine eligibility and continued eligibility in the CDRP as described in thePresentation of Persons (2003) Regulations. My contact information may also be used by the CBSA to send me notifications related to changes to the CDRP.

In addition, I understand that my personal information gathered for the purposes of this application, including my supporting documentation, background information, biometric data, as well as any other information obtained and collected for the purpose of the operation of the CDRP and to conduct applicable checks and verifications to determine my eligibility and continued eligibility in the CDRP, may be accessed and used by the CBSA, as well as by other government departments or agencies in Canada (including the Royal Canadian Mounted Police and the Canadian Security Intelligence Service), in accordance with the Privacy Act.

If you do not consent to the above-noted collection, use, and sharing of your personal information, your application cannot be processed and an authorization cannot be granted.

Do you consent to the above-noted collection, use, and sharing of your personal information? (Yes/No)

Certification

I certify that all information given on this application, and in support of this application, is provided voluntarily and is true, accurate, and complete.

I certify that I have read, understood, and agree to abide by all conditions applicable to the program to which I apply and to the use of the associated authorization, including all instructions and notices accompanying this application.

Do you certify? (Yes/No)

• Applicant's signature
• Date (YYYY/MM/DD)

Important

You must include a photocopy of all documents, including your driver's licence, so we can process your application. The following documents are acceptable proof of citizenship: birth certificate, passport, or naturalization certificate. The following documents are acceptable proof of residency: Confirmation of Permanent Residence (IMM5292), or a valid permanent resident card.

Date modified:

2022-07-12