Notification of Security Clearance - Form 4195e

REQUIREMENT FOR COMPLETION: In accordance with the Policy on Government Security, both the requirement for and the processing of a personnel security screening action must be based on a specified need. Please do not initiate the completion of this or any other security screening form unless this need has been identified by the federal government department/agency that requested you to complete them.

NOTE: This form has been developed in a way that it allows you to fill in all the necessary information using your computer. It should be noted, however, that to comply with privacy concerns and safeguard against the inadvertent retention of personal information within a non-secure security screening database, you will not be able to save or return to a partially completed version of this form. Prior to attempting to complete this form, it is critical you pay special attention to obtain both the information required and carefully read the instructions provided. Failure to do so will only result in the need to re-key previously entered data. If necessary, please contact your security office for specifics. For security reasons and to ensure that your own privacy rights are being safeguarded, security forms available on our CSIS website must be sent by Encrypted email to the CSIS Security Screening Branch’s Client Liaison by the requesting Department / Client.

Mailing address: Canadian Security Intelligence Service
P.O. Box 9732, Postal Station "T"
Ottawa ON K1G 4G4
Attention: Security Screening
Fax: 613-842-1355

This document is available in Adobe Acrobat format. If you do not have an Adobe Acrobat Reader or are unfamiliar with Adobe Acrobat, refer to the alternative formats and plug-ins.

Fillable PDF Form

(Enter information electronically, sign, Encrypt, submit by email)

NOTE: In order to make use of all of the features of a fillable PDF form, you should use version 5 or higher of the Adobe Acrobat Reader. This form has been developed in such a way that it allows you to fill in all the necessary information, except your signature, using your computer. You will not be able to save or return to a partially completed version of this form. Prior to attempting to complete this form, it is critical that you obtain the information required and carefully read the instructions provided. Failure to do so will result in the need to re-key previously entered data. If necessary, please contact your security officer for specifics.

Note: Printable Version Available

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