ABORIGINAL DECLARATION FORM

(PROTECTED when completed)

To determine your eligibility for the position, please complete the appropriate section(s) below:

1.  I declare that I am a Status/Registered/Treaty Indian because of my Aboriginal affiliation with the

_______________________________________________________ Nation

and my Band/ Treaty Number is __________________________________.

Additional comments:

_____________________________________________________________

2.  I declare that I am a non-Status Indian because of my Aboriginal affiliation with the

_______________________________________________________ Nation

Additional comments:

_____________________________________________________________

3.  I declare that I am Métis because:
I am enrolled as a beneficiary of the

_________________________________________________________ land
claim agreement, OR

of my Aboriginal affiliation with the

____________________________________________________ Nation

_________________________________________________________OR

I am affiliated with the following Métis community:

_____________________________________________________________.

Additional comments:

_____________________________________________________________

4.  I declare that I am an Inuk because:
I am enrolled as a beneficiary of the

________________________________________ land claim agreement, OR
I am a member of the Labrador Inuit Association, or
I am affiliated with the following Inuit community:

_____________________________________________________________.

Additional comments:

_____________________________________________________________ All the information I have given herein is true and complete and may be verified.

NOTE: The information you provide on this document is collected for the purpose of verifying eligibility for Aboriginal targeted staffing activities within the Department of Indian and Northern Affairs Canada. Personal information will be protected under the provisions of the Privacy Act and will be held as part of all other documents submitted for a specific staffing process.

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