Application for Certificate to Act as an Examiner

Note: If you are certified as an examiner, please be advised that your name, city/town and the telephone number provided will be made available to the public.

Applicant Information

Last Name (required)

First Name (required)

Middle Initial

Telephone Number (required)
(Format: Must be 10 numbers)

Email Address (required)
(Example: name@example.com)

Note: A confirmation will be sent to the email address you provide.

Confirm Email Address (required)
(Example: name@example.com)

Current Occupation

Address

Postal Code (A#A #A#) (required)

(if necessary, continue to select the Postal Code Lookup button until your correct street name is shown or complete the address fields with the correct information)

Unit Number

Street Number (required)

Street Name (required)

PO Box

Lot/Concession

City/Town (required)

Province (required)

Application Detail

1. Have you ever worked at or operated an abattoir or meat processing plant?(required)

Yes

2. Have you ever been convicted of an offense relating to the following, or owned or worked for a business that has been convicted of (a) cruelty to animals, (b) illegal operation of an abattoir or meat plant, (c) illegal slaughter of animals?(required)

Yes

3. Please explain any other past professional experiences that may be applicable to the duties of an examiner, such as slaughtering animals or assessing animal conditions.

I certify that the information submitted in this application is true and correct to the best of my knowledge.

Personal information on this form is collected as it is necessary for the proper administration of Part III.1 of Ontario Regulation 31/05: Meat under the Food Safety and Quality Act, 2001, S.O. 2001, c.20. It will be used for the purpose of issuing a certificate to act as an Examiner (Non Emergency Slaughter of Food Animals on Producer Premises). Questions regarding the collection should be directed to the Manager, Veterinary Services Unit, Animal Health and Welfare Branch, Ontario Ministry of Agriculture, Food and Rural Affairs, 1 Stone Road West, Guelph ON N1G 4Y2, at 519-766-2537.

Confirmation: (required)

I have read and agree to the Declaration and have read, agree and consent to the Collection and Use of Information as stated above.

I do not agree and consent.

Name (First and Last Name) (required)

Title

Date:

You must agree to both the Declaration and the Collection and Use of Information stated on the previous page to submit this form online.

Summary Review

Note: To make changes to the information below, please click the “Make Change” button (at the bottom of this page) to access previous pages to make corrections.

Section 1 – Applicant Information

Last Name

First Name

Middle Initial

Telephone Number

Current Occupation

Address

Unit Number

Street Number

Street Name

PO Box

Lot/Concession

City/Town

Province

Postal Code

Section 2 – Application Detail

1. Have you ever worked at or operated an abattoir or meat processing plant?

Yes

If yes, please indicate by checking applicable boxes, explain when, where (name) and location:

Abattoir

Processing Plant

Operated

Worked

Explain when, where (name) and location

Yes

If yes, please provide details of the conviction(s) and why it would not be in the public interest to refuse to issue this certificate to you as well as why there are grounds to believe that you will act in accordance with the law.

3. Please explain any other past professional experiences that may be applicable to the duties of an examiner, such as slaughtering animals or assessing animal conditions.

Section 3 ‐ Collection and Use of Information

Notice of Collection of Personal Information

Declaration

I certify that the information submitted in this application is true and correct to the best of my knowledge.

Name (First and Last Name)

Title

Date

You will receive an email confirmation which contains a confirmation number for your records.

Unfortunately, we are unable to process your request at this time.

Please check your internet connection and try again later.

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Form ID

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Applicant Email Address

Applicant CC Email Address

Applicant Email Body

Applicant Subject

Applicant From Email Address

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Program Area CC Email Address

Program Area Email Body

Program Area Email Subject

Program From Area Email Address

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Application for Certificate to Act as an Examiner

Application for Certificate to Act as an Examiner (application in progress)

Application for Certificate to Act as an Examiner (application in progress)

Application for Certificate to Act as an Examiner(application in progress)

Application for Certificate to Act as an Examiner(application in progress)

Application for Certificate to Act as an Examiner(application in progress)

Declaration

Collection and Use of Information

Notice of Collection of Personal Information

Application for Certificate to Act as an Examiner(application in progress)

Application for Certificate to Act as an Examiner(application in progress)

Summary Review

Section 1 – Applicant Information

Address

Section 2 – Application Detail

Section 3 ‐ Collection and Use of Information

Notice of Collection of Personal Information

Declaration

Application for Certificate to Act as an Examiner (application in progress)

Application for Certificate to Act as an Examiner (application in progress)