Member Conduct Disclosure Form

Confidential Information
For Internal Use Only

Each member assigned to an investigation must complete a separate form and submit with the
RCC.

COORS File No.: Accused Surname:

Member’s Surname: __Kilback_____ Employee#:__014309

Accused In-Custody: Yes □ No x

Please check the appropriate box:

Yes No
1. □ x I have a substantiated complaint on my Disciplinary Record that has not been
expunged.
2. □ x I am the subject of an on-going Police Act complaint.
3. □ x I have been charged or convicted of an offence under the Criminal Code, or the
Controlled Drugs and Substances Act for which I have not been pardoned.
4. □ x I have been convicted of an offence under a federal statute or provincial act
(except for speeding under the Motor Vehicle Act or a similar Act).
Specify_________________________________
5. □ x I have been charged or convicted of an offence analogous to a criminal offence
in another or foreign jurisdiction.
6. □ x I ask that I be notified by the File Coordinator of an intention to disclose my
record and that I be given an opportunity to make further submissions before
disclosure occurs.

The information I have provided is true to the best of my knowledge and belief. I am aware that I have a
continuing obligation to provide up-to-date information should circumstances change.
Detective Digitally signed by Detective Sergeant
Aaron Kilback

Member Signature: ___________________________

Sergeant Aaron
DN: cn=Detective Sergeant Aaron Kilback,
o=Conservation Officer Service, ou=Special
Investigations Unit,
Date: ____________________
Kilback email=aaron.kilback@gov.bc.ca, c=CA
Date: 2011.02.20 14:00:06 -08'00' (YYYY/MM/DD)

File Coordinator:
If member has indicated “Yes” to any of questions 1 – 6, this form must be forwarded to the
Superintendent/ Provincial Investigations Unit, labeled: “Confidential - for review by Superintendent/
Provincial Investigations Unit
 Police Witness Disclosure Form
Confidential Information - For Crown Counsel Use
General Occurrence No.: _________________________________

Accused Surname: _________________________________ Page _____ of _____

Officer Witness List
No Relevant
Record* Record, McNeil
Member’s Surname Employee# No Record
see other Package Attached*
side
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* File Coordinator signature required even if no officer on the list has a record.

Signature: ____________________________ Employee No.: _______ Date:___________

File Coordinator/Crown Liaison (YYYY/MM/DD)