Affirmation Of Aboriginal Affiliation Form

RTF Version (3.86 Mb)

PROTECTED B when completed

Appointment Process Number:

Group:

Level:

Position Title:

This information is being collected by (insert name of department/agency) for the purpose of confirming the eligibility of the person proposed for appointment and safeguarding the integrity of the appointment authorities which have been delegated by the Public Service Commission (PSC) to (insert name of department/agency).

The Affirmation of Aboriginal Affiliation Form (AAAF) must be completed and signed by the person claiming Aboriginal status prior to appointment if he or she has self-declared as Aboriginal within the appointment process that:

  • has an area of selection limited to Aboriginal peoples, or to members of designated employment equity groups that include Aboriginal peoples; or
  • has applied as a merit criterion the organizational need of increasing the representation of Aboriginal peoples, or increasing the representation of members of designated groups, including Aboriginal peoples; or
  • involves selection from an Aboriginal inventory, or Treasury Board of Canada Secretariat approved student employment programs used to increase the representation of Aboriginal peoples, or of designated groups, including Aboriginal peoples.

An appointment cannot take effect unless the person proposed for appointment has completed and signed the AAAF. Providing false or misleading information pertaining to a person's Aboriginal affiliation may result in rejection of this application or corrective action such as revocation of the appointment, following an investigation by the PSC or its delegate.

In the event of an investigation pursuant to sections 15, 66, 67 or 69 of the Public Service Employment Act, the person proposed for appointment or appointed will be required to substantiate the information provided on the AAAF.

Affirmation

An Aboriginal person is a North American Indian or a member of a First Nation, a Métis, or Inuit. North American Indians or members of a First Nation include status, treaty or registered Indians, as well as non-status and non-registered Indians.

I declare that I am an Aboriginal person and I understand that providing false or misleading information will be cause for rejection of my application, or cause for revocation of my appointment, following an investigation by the PSC or its delegate.

Candidate name (Print)

Signature

Date (YYYY-MM-DD)

Privacy Notice Statement

The personal information provided in this document is collected under the authority of the Public Service Employment Act and will be protected under the Privacy Act. The information collected will be kept on the staffing file by the hiring department or agency under the Treasury Board Secretariat standard personal information bank – registration number PSE 902, which is detailed at: www.infosource.gc.ca. Under the Privacy Act,you have the right to request access to your personal information held by a federal government institution, and to request corrections, should you believe the information contains errors or omissions.