Form 18 (Complaint re Security Clearances)

National Security and Intelligence Review Agency (NSIRA) – FORM 18

SECTION A – PERSONAL INFORMATION

Title
Last Name
First Name
 
 
 
Address
 
Telephone number

Date of Birth

 
 
Email
 
Department or Deputy Head responsible for the Denial of my Security Clearance
 

If your security clearance was denied or revoked, the NSIRA Act provides that the deputy head of the federal department or agency where you were employed or were seeking employment must advise you in writing within 10 days of making that decision. Once you receive this notice, you have 30 days to file a complaint with NSIRA. You may contact NSIRA at the following address:

National Security and Intelligence Review Agency
P.O. Box 2430
Station D
Ottawa, ON K1P 5W5

Once your complaint is received, NSIRA will contact you to follow up on the information you provided. For further information, please contact the Registrar at 1-833-890-0293.

SECTION B – DETAILS OF HOW THE CLEARANCE DENIAL HAS LED TO A DENIAL OF EMPLOYMENT, A DISMISSAL, A DEMOTION OR A TRANSFER



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SECTION C – CERTIFICATION

□ I am submitting this complaint within 30 days of receipt of the letter by the institution

If not:
Here are the reasons why the complaint was not submitted within 30 days:

 

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□ I am enclosing a copy of the denial or revocation of security clearance letter received from the Deputy Head


Signature:
 
Date:
 

 

PROTECTED B WHEN COMPLETED – PERSONAL INFORMATION

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