Fillable Printable Federal Police Check Form - Australia
Fillable Printable Federal Police Check Form - Australia
Federal Police Check Form - Australia
Office use only
Australian Federal Police
National Police Check (NPC) Application Form
Please complete this form by referring to the Application Completion Guide.
1. Purpose of NPC
Code Number:
Enter the relevant code number from the tabl e at Se ction 1: Purpose of NPC on
the Application completion Guide (e.g. Fire fighting/prevention = Code No 15)
If a code is not specified this application will be processed as a Standard Disclosure (Code 30).
If the purpose is not listed or you are unsure please ring the AFP Criminal Records
Help Desk on 02 6202 3333 for assistance.
2. Applicant Details
If completing manually, use BLOCK LETTERS and black ink. Mark check boxes with a cross (X).
Current Family Name
All Given Names
Date of Birth (DD/MM/YYYY) Gender: Male Female
Previous or Other Names by which you are known or have been formerly known must be listed below (eg. maiden, deed poll).
If more room is required, list on separate sheet, sign and send with this application fo
rm. Additional information sheet included
Family Name: (include all name changes and maiden name) Given Names Date of Birth
State
Country
Telephone Numbers: Home
Work
Mobile
Australian Drivers Licence Number
Issuing State:
Copy Attached
Current Residential Address – Complete in FULL
Unit No. Street No. Street Name / Street Type
Suburb/City Post Code
State Country
Previous Residen t ial Address – Compl et e in FUL L
Unit No. Street No. Street Name / Street Type
Suburb/City Post Code
State Country
3. This is a private (ie non-account) application, do not complete this section.
Form CR501 Version 1.05 Page 1 of 6
Place of Birth Town
Date you started living at this address
Date you started living at this address
4. Mailing Address for Police Certificate
Is the Police Certificate to be posted to your current residential address? Yes No
If NO: I authorise the Police Certificate to be forwarded to the following person/organisation:
Name
Unit No. Street No. Street Name / Street Type
Suburb/City Post Code
State Country
5. Fingerprints Please note that a fingerprint check is only required under very limited circumstances.
Please ensure that you
are actually required to have a fingerpri
nt check conducted before going to the
expense of this level of check by checking with the organisation/department requesting the check.
Is a fingerprint check required? Yes No If yes, fingerprints must be submitted with this form. In addition choose only one of the
below statements. For information on fingerprint checks see Section 5: Fingerprint Checks on the Application Completion Guide.
I have attached:
(a) fingerprints taken by anot
her police jurisdiction OR
(b) fingerprints tak
en by the AFP and not charged when taken OR
(c) fingerprints taken by th
e AFP and charged when taken - receipt of payment must
be supplied with this form
6. Consent
i. I acknowledge I have read the Application Completion Guide for this application form (pages 3 – 6) and I am aware exclusions from spent
convictions legislation may apply to some categories of NPCs.
ii. The personal
information I have provided on this form (including fingerprints if supplied) relates to me and is correct.
iii. I acknowledge th
e details contained on this form, including fingerprints where relevant, will be forwarded to the AFP, CrimTrac, and/or the
Police Services of the States or Territories of the Commonwealth of Australia.
iv. I consent to the AFP and any oth
er Australian police force extracting details of any convictions, findings of guilt or pending court proceedings
relating to me, including in relation to any traffic offence, and providing that information to me or to the Employer/Organisation named in
Section 3 above, as approved or to another person agency as named in Section 4.
v. I acknowledge th
e information provided on this form will not be used without my prior consent for any other purpose, unless otherwise
authorised by law.
vi. I acknowledge th
at any information provided on this form or disclosed by the police as a result of the records check may be taken into
account by the organisation mentioned in (3) above or any organisation to whom I present the results of the records check in assessing my
suitability to receive the entitlement.
vii. I acknowledge that only details contained in this application or on attachments signed by me will be checked and that should I subsequently
require further names and/or details to be checked then I will be required to submit a further application and payment.
Applicant’s Signature
Date
/ /
If you are under 18 years of age please provide consent below from a parent/guardian.
Parent/Guardian Signature
Date
/ /
Parent/Guardian name printed in full
PLEASE ENSURE THAT YOU HAVE ENCLOSED A COPY OF YOUR IDENTIFICATION AND THE CORRECT FEE WITH THIS APPLICATION
Form CR501 Version 1.05 Page 2 of 6
FINANCIAL SERVICES
Locked Bag 8550 CANBERRA ACT 2601
Telephone 02 6202 3333
Email:[email protected]
www.afp.gov.au
ABN 17 864 931 143
Application Completion Guide
BLOCK LETTERS MUST BE USED WHEN COMPL
E
TING THIS APPLICATION MANUALLY
Section 1: Purpose of NPC
Applicants must choose one purpose only
from the following list. Identify the relevant code
and insert in the appropriate box on page 1 of the NPC form.
If the purpose for your NPC is not listed or you ar
e unsure please ring the Criminal Records Help
Desk on 02 6202 3333 between 9am and 5pm (Australian Eastern Standard Time).
Code
number
Working in the Australian Capital T err itory (ACT) Offences recorded in the ACT that will be
released (Spent Convictions Act 2000)
10 Aged Care provider/worker All offences
11 Brothel or Escort Agency Owner/Operator/Interested party All offences
12 Child Care provider/worker All offences
13 Disabled Care provider/worker or Hospital Employment All offences
14 Explosives/fireworks permit (where an ASIO check is required) Unspent offences
15 Fire fighting/prevention Unspent offences and Arson or Attempted Arson
offences
16 Firearms Licence/permit All offences
17 Interactive Gambling Licence/Casino Employee All offences
18 Judge/Magistrate/Justice of the Peace/ Police Officer/Prison
Officer
All offences
19 Child/Aged/Disabled Care provider/worker All offences
20 Working in a School All offences
21 Teacher/teacher’s aide All offences
30 Pre employment/standard disclosure, Security Guard Unspent offences
Commonwealth purpose/employment Offences recorded in the Commonwealth that will
be released (Part VIIC Crimes Act 1914)
22 Aged Care staff/volunteers Unspent offences and offences against the person
23 Aged Care Key Personnel Unspent offences
24 Australian Securities and Investments Commission (ASIC)
employee/consultant
All offences
25 Australian Securities and Investments Commission (ASIC)
Consumer Credit/Financial Services Licensing Requirements
Unspent offences
26 AUSTRAC employee/consultant All offences
27 Care of intellectually disabled persons Unspent offences and offences against the person
28 Care, instruction or supervision of children Unspent offences a) a sexual offence; or (b) any other
offence against the person if the victim of the offence
was under 18 at the time the offence was committed
29 CASA ASSC Unspent offences
30 Commonwealth department employee Unspent offences
31 Employee with access to secret or top secret information All offences
32 Immigration Detention Centre Employment Unspent offences and offences involving violence
33 Immigration/Citizenship ** Please note that fingerprints
are not required
by the Department of Immigration and
Citizenship (DIAC) unless you are otherwise advised by
them
All offences
34 Law enforcement/Intelligence or Security agency
employee/consultant (NB NOT private Security Guards
)
All offences
35 Overseas employment/visa Unspent offences
36 Superannuation Trustee/Custodian/Investment manager or
Responsible officer of a body corporate that is a trustee,
investment manager or custodian of a superannuation entity
Unspent offences and offences in
respect of dishonest
conduct
37 Care, instruction or supervision of children/ Care of
intellectually disabled persons/ Aged Care staff/volunteers
Unspent offences, offences against the person and i) a
sexual offence; or (ii) any other offence against the
person if the victim of the offence was under 18 at the
time the offence was committed
Other
30 Pre employment/standard disclosure Unspent offences
Form CR501 Version 1.05 Page 3 of 6
Section 2: Applicant details
Please ensure ALL applicant details are provided in
cl
uding all current and previous names.
If there is insufficient room, please attach a
separate sheet, ensuring that it is signed and dated.
Section 3: Employer/Organisation details
This section relates to AFP account holders only
.
Section 4: Mailing Address of Police Certificate
If this section is completed by the applicant, the applicant is consenting to the Police Certificate
being mailed to
the person/organisation listed.
Section 5: Fingerprint Checks
are only required where there is a legislative requirement for
such a check to be conducted. The employer or organisation requiring the NPC will advise you if
this is necessary.
These fingerprints must be included with pages 1 and 2 of this form at the time of
submission.
An add
itional cost and processing time is associat
ed with this service. Details are available on
the AFP website or use the link – http://www.afp.gov.au/what-we-do/police-checks.aspx
Fingerprints can be
taken by your local police jurisdiction or the AFP. Where fingerprints are
taken by
the AFP and the AFP charges for this service a receipt must be obtained and supplied to
Criminal Records with this application.
Section 6: Consent
This section must be signed by the applicant. If a parent/guardian has signed in the consent
sect
ion
they consent to the AFP conducting a NPC on their son/daughter/ward.
Form CR501 Version 1.05 Page 4 of 6
Spent Convictions Legislation
The aim of spent convictions legislation is to pre
vent discrimination on the basis of certain
previous convictions. Spent convictions legislation limits the use and disclosure of older, less
serious convictions and findings of guilt.
There are some offences excluded from being spent where
the check is required for certain
purposes as indicated in the table above – these offences will be released regardless of how old
they are.
Where a record exists within an Australian police jurisdiction, relevant spent conviction
legi
slation/policies governing the release of that information for that jurisdiction will be applied.
As a result certain convictions will not be released provided this is in accordance with the
relevant legislation/policies.
For Commonwealth records the AFP applies the provisions within Par
t VIIC of the Crimes Act
1914 and for ACT records provisions within the ACT Spent Convictions Act 2000 are applicable.
If further information or clarification is required please contact the individual jurisdiction where
the re
cord is held.
Provision of False or Misleading Information
You are asked to certify that the personal information
you have provided on this form is correct.
Where your check is for employment related purposes and the result is to be provided to your
employer or other organisation, discovery of any false or misleading information may be
reported by the AFP and may impact on the decision being undertaken by the employer or
organisation.
The AFP provides information, with your consent, to the emp
loyer or organisation but takes no
part in any subsequent assessment.
Disputed Record Enquiries
If you believe the information provided on your po
lice certificate is incorrect or inaccurate
contact AFP Criminal Records to obtain a Disputed Record form (CR 1200). This form is also
available from the AFP website.
Include any additional information or documents supporting your enquiry to enable the AFP to
more ac
curately assess your application. In some instances the AFP may require comparison
fingerprints to resolve some disputes. Applicants will be notified in such instances.
The Privacy Commissioner is responsible fo
r ensuring the protection of private information
relating to individuals. This includes investigating instances where information has been
released improperly or incorrectly. An individual who believes the standards dealing with
disclosure and use of old conviction information have been breached may apply to the Privacy
Commissioner for an investigation of the matter. The phone number is 1300 363 992.
The following requirements
must
be met when submitting an AFP National Police Check (NPC).
Form CR501 Version 1.05 Page 5 of 6
Completion Check List
Failure to meet the required standards will result in the form being returned for amendment.
o
Ensure Section 1 Purpose of NPC has been completed
o Payment of the required fee is to be
in exact
Australian Dollars only.
o Do NOT send cash.
o Applications with incorrect amounts of money will be re
turned.
o Details are available on the AFP website or use the link –
http://www.afp.gov.au/what-we-do/police-checks/national-police-checks.aspx
o A copy of an Australian driver’s licence or other acceptab
le identification (eg
passport, certified full birth certificate, certified marriage certificate) must
accompany the application. Do not send original documents.
o Ensure a
l
l the necessary details have been completed and the form is signed and dated.
o If completing by hand please use BLOCK LETTERS and black ink.
o Mark the appropriate check boxes with a cross (X).
o A
ll previous or other names by which you are known or have been formerly known,
includ
ing maiden name, must be listed in full on the form or on an enclosed additional
sheet.
o Any attachments with additional information m
ust be signed by the applicant
.
o The form must be submitted no more than three months after being signed by the
applicant.
o If the applicant is under 18 years of age the form must be signed by a parent/guardian.
o Do not sen
d the Application Completion Guide (pages 3 – 6 of this form) to the AFP.
Please retain these for your reference.
If you are submitting your NPC directly to the AFP (rather than
through your employer or
organisation) the following is also required:
o Make the cheque or money order payable to the Australian Federal Police.
o Any cheques must be from an Australian bank or a bank that is affiliated with an
Austra
lian bank.
o Payment must be in Australian Dollars (ie $AUD)
o Correct payment mu
st be included with all applications.
Post all applications to:
Australian Federal Police
Criminal Records
Locked Bag 8550
CANBERRA ACT 2601
Form CR501 Version 1.05 Page 6 of 6
