APPLICATION FOR QUALIFIED CANNABIS WORKER
50 Corriveau Avenue Phone: 780‐447‐8600 Email: [email protected]
St. Albert, Alberta T8N 3T5 Toll Free: 1‐800‐272‐8876 Website: aglc.ca
Please allow two to four weeks for processing
First‐time application Re‐applying for QCW No.
NAME
Last Name First Name Middle Name(s)
OTHER ALIAS(ES)
DATE OF BIRTH CANADIAN CITIZEN
Year Month Day LANDED IMMIGRANT
OTHER (Describe)
PLACE OF BIRTH
City, Province, Country Email Address
MAILING ADDRESS HOME ADDRESS Same as mailing address OR
Apt #, Street Address or PO Box Apt #, Street Address or PO Box
City, Province Postal Code City, Province Postal Code
CONTACT PHONE
SELLSAFE CERTIFICATION
SellSafe Reg #: Expiry Date:
ARE YOU CURRENTLY OR HAVE YOU EVER BEEN CHARGED WITH A CRIMINAL OFFENCE?
No Yes, provide details
Date of Charge or Conviction Place of Charge or Conviction Offence Outcome
1. Answer “Yes” even if:
i. The charges were dismissed or subsequently downgraded to a lesser charge.
ii. You completed an alternative measures or other similar program.
iii. You were charged but not convicted.
iv. You did not serve any time in prison.
v. The investigation, charges or offences happened in another jurisdiction.
2. Answer “No” if:
i. You received a pardon under the provisions of the Criminal Records Act (Canada) or similar legislation, or if any records
relating to a charge or conviction have been expunged or otherwise officially sealed by a court or government agency.
ii. You were charged under the provisions of the Young Offenders Act (Canada) or other similar legislation.
iii. You have never been charged with a criminal offence.
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FORM RS/CAN 8013 (2022 Sept)
ALL APPLICANTS MUST ATTACH BOTH OF THE FOLLOWING TO THIS APPLICATION:
1. Identification:
o For first time applicants born in Canada, attach a copy of one of the following: birth certificate, Canadian passport,
government issued Indian Status Card or Alberta Identification Card.
o For first‐time applicants born outside Canada, a copy of one of the following Immigration documents: Canadian
passport, Permanent Resident Card, landed immigration document, current work/study permit, or official Canadian
Citizenship Certificate (front and back).
*Please note: Operator (Drivers) Licences are not accepted for identification purposes.
2. Criminal Records Check:
o Current criminal records check from local city police or local RCMP detachment (dated within three months of issue).
o On‐line or third party criminal records checks will NOT be accepted with the exception of Edmonton Police Service
(EPS) or Calgary Police Service (CPS).
INCOMPLETE APPLICATIONS WILL NOT BE PROCESSED AND WILL BE RETURNED TO THE APPLICANT
NOTICE TO APPLICANTS
If mailing application and supporting documents, mail to: AGLC, 50 Corriveau Avenue, St. Albert AB T8N 3T5
Qualification is valid up to five years. It is the responsibility of the applicant to ensure renewal of qualification prior to
expiry.
Applications will be reviewed throughout the qualification period. If an individual fails to comply with AGLC policies or is
charged with or convicted of an offence under the Gaming, Liquor and Cannabis Act; the Gaming, Liquor and Cannabis
Regulation; or criminal offence, the qualification may be cancelled.
INDUSTRY TRAINING
AGLC policy requires licensees to ensure their staff have and maintain the SMART certifications required for their position(s).
For help or more information, visit https://smartprograms.aglc.ca/requirements.aspx, call 1‐877‐436‐6336 or send an email to
[email protected]
I CERTIFY THAT:
All information provided as part of the application is truthful and complete.
Any criminal charges or convictions will be reported to AGLC immediately.
I authorize AGLC to undertake a criminal records check or inquire with any police agency to determine my eligibility to be
qualified as a cannabis worker.
I understand that a false statement or failure to meet AGLC conditions may result in my qualification being refused or
cancelled.
I have read and understand the conditions of qualification as outlined on page three of this application.
Applicant’s signature Date
Protection of Privacy – The personal information requested on this form is collected under the authority of Section 33(c) of the
Freedom of Information and Protection of Privacy Act and will be protected under Part 2 of that Act. The information will be used to
determine eligibility for employment for qualified cannabis workers. Direct any questions about this collection to: AGLC FOIP
Coordinator, 50 Corriveau Avenue, St. Albert, AB T8N 3T5, 780‐447‐8600 or toll free at 1‐800‐272‐8876.
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FORM RS/CAN 8013 (2022 Sept)
QUALIFIED CANNABIS WORKER – REQUIREMENTS
The Alberta Gaming, Liquor and Cannabis Regulation states: 3) A Qualified Cannabis Worker must notify the AGLC and
the licensee immediately when charged with or convicted
1) A cannabis licensee may not employ any person to sell of an offence under:
cannabis or to assist the licensee in the conduct or a) the Criminal Code (Canada);
management of a licensed activity unless the person: b) the Excise Act (Canada);
a) is an adult; c) the Food and Drugs Act (Canada);
b) has successfully completed the training d) the Income Tax Act (Canada);
requirements set by the AGLC, and e) the Controlled Drugs and Substances Act (Canada);
Please Detach and Retain for Your Information
c) has passed a records check to the satisfaction of f) a foreign Act or Regulation that is substantially
the Board. similar to an offence referred to in a), b), c), d) or e)
above; or
2) For the purposes of subsection (1)(c), a person does not g) the Gaming, Liquor and Cannabis Act (Alberta) or
pass a records check if the person: Gaming, Liquor and Cannabis Regulation (Alberta).
a) has at any time been charged with or convicted of:
i. an offence under the Criminal Code (Canada), 4) If a Qualified Cannabis Worker is charged or convicted, as
the Excise Act (Canada), the Food and Drugs described above, the AGLC may take action including, but
Act (Canada); not limited to, refusal to qualify, or suspension or
ii. an offence under the Controlled Drugs and cancellation of the qualification.
Substances Act (Canada), other than under
section 41 of that Act for possession of any 5) Any changes to personal information must be reported to
substance included in Schedule II to that Act, AGLC immediately by email to [email protected]
or or by calling the Registrations Unit at 780‐447‐8600 or toll
iii. an offence under a foreign Act or regulation free at 1‐800‐272‐8876.
that, in the opinion of the Board, is
substantially similar to an offence referred to NOTICE TO APPLICANTS
in sub‐clause i. or ii.
Qualification is subject to all information provided on the
and, in the opinion of the Board, the offence is application being truthful and complete.
sufficiently serious that it may detract from the
orderly or lawful conduct of activities authorized by The AGLC will review the qualification if an individual fails to
a cannabis licence; comply with the above, is charged with, or convicted of, a
criminal offence. This review could lead to the qualification
b) has, within the five years prior to being employed being suspended or cancelled.
by the cannabis licensee, been serving a term of
imprisonment of three years or more; or RE‐APPLYING
c) in the opinion of the Board, has committed any act Qualification can only be completed by reapplying. When
that is contrary to the public interest or that reapplying, you will not be required to provide identification.
detracts from the integrity with which cannabis‐
related activities are to be conducted in Alberta. It is the responsibility of the applicant to ensure SellSafe
Certification is valid throughout the qualification term.
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