Fillable Printable National Police Checking Service Application Form - Australia

National Police Checking Service Application Form - Australia

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY SOCIAL WORK ABN 63 968 822 144

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY GENERAL WORK ABN 81 404 0247 599

NATIONAL POLICE CHECKING SERVICE

APPLICATION FORM (NO EXCLUSION)

PERSONAL INFORMATION

(Employee to complete)

NAMES BY WHICH I AM, OR EVER HAVE BEEN, KNOWN (including changes by Deed Poll)

1. Surname: (current) ____________________________ Given Names: (current) ________________________________

2. Surname: __________________________________ Given Names: ______________________________________

SEX: M F (Please Circle) DATE OF BIRTH: _______ / _______/ _______

Day Month Year

PLACE OF BIRTH: __________________________________________________________________

Suburb/Town State/Territory Country

PHONE NUMBER: ________________________ MOBILE: _________________________________

PASSPORT: __________________________________________________________________________

Type (Gov, Priv or UN Refugee) Number Passport Country

DRIVER’S LICENCE NUMBER: ___________________________ ISSUED BY: __________________

FIREARMS LICENCE NUMBER: ____________________________ STATE/TERRITORY:____________

I am a/an: Employee Officer Volunteer (Please Circle)

Permanent Residential Address over Last Five Years

If full details of previous addresses are unavailable details of town(s) and

state(s) will suffice. Attach list if insufficient room.

If actual dates are unavailable, Details

of year of residence will suffice

Current Address:

Address:

Suburb: Postcode: State:

Period of residence

/ / to / /

Address:

Suburb: Postcode: State:

/ / to / /

Address:

Suburb: Postcode: State:

/ / to / /

Address:

Suburb: Postcode: State:

/ / to / /

Address:

Suburb: Postcode: State:

/ / to / /

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY SOCIAL WORK ABN 63 968 822 144

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY GENERAL WORK ABN 81 404 0247 599

NATIONAL CRIMINAL HISTORY CHECK

CONSENT TO OBTAIN PERSONAL INFORMATION

(NO EXCLUSION)

(Please print in BLOCK LETTERS and BLACK INK)

I, _______________________________ ____________________________________________________ hereby:

Family Name (Current) Given Names (Current)

1. acknowledge that I have read the Spent Convictions Schemes section of the information sheet and understand that

Spent Convictions legislation (however described) in the Commonwealth and many States and Territories protects

“spent convictions” from disclosure;

2. understand that the position/entitlement for which I am being considered is in a category for which NO exclusion has

been granted from the application of the Spent Convictions legislation;

3. have fully completed this Form, and the personal information I have provided in it relates to me, contains my full name

and all names previously used by me, and is correct;

4. acknowledge that the provision of false or misleading information is a serious offence;

5. acknowledge that I am providing information to the CrimTrac Agency (an Agency of the Commonwealth of Australia)

and the Australian police services by consenting to The Salvation Army (Australia Eastern Territory) providing personal

information about me from this Form;

6. consent to:

i. the CrimTrac Agency disclosing personal information about me to the Australian police services;

ii. the Australian police services disclosing, to the CrimTrac Agency from their records, details of convictions and

outstanding charges, including findings of guilt or the acceptance of a plea of guilty by a court, that can be disclosed

in accordance with the laws of the Commonwealth, States and Territories and, in the absence of any laws governing

the disclosure of this information, disclosing in accordance with the policies of the police service concerned; and

iii. the CrimTrac Agency providing the information disclosed by the Australian police services to The Salvation Army

(Australia Eastern Territory) in accordance with the laws of the Commonwealth; and

7. acknowledge that any information provided by me on this Form, or by the Australian police services, may be taken into

account by The Salvation Army (Australia Eastern Territory) in assessing my suitability for the

for which I am being considered.

< specify position/entitlement>

Signature: _____________________________________ Date: ________________

Note: The information you provide on this Form, and which the CrimTrac Agency provides to The Salvation Army

(Australia Eastern Territory) on receipt of the Form, will be used only for the purpose stated above unless

statutory obligations require otherwise.

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY SOCIAL WORK ABN 63 968 822 144

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY GENERAL WORK ABN 81 404 0247 599

NATIONAL POLICE CHECKING SERVICE

‘100 POINT CHECK’ VALIDATION CHECKLIST

Manager to complete

Centre/Site: _______________________________________________

Cost Centre: __ __ __ __ - __ __ __ __ - __ __ - __ __ __ __ __

1. Primary Documents (Only one form of identification accepted from this

category) NAME verified from one of the following:

Available Points per Item

Points

Scored



Birth Certificate



Birth Card issued by the New South Wales Registry of Births, Deaths and Marriages



International Travel Document

 A Current Passport

 Expired Passport which has not been cancelled and was current within the preceding 2 years



Citizenship Certificate

2. Secondary Documents

NAME verified from one of the following (only where they contain a photograph or

signature that can be matched)

Available Points per Item

Additional documents can be

awarded 25 points

Points

Scored



Australian Driver’s Licence / Permit



Public Service ID Card



Tertiary Student ID Card



Social Security Benefits Card

3. Tertiary Documents

NAME and ADDRESS verified from any of the following:

Available Points per Item

Points

Scored



Reference from current employer, or previous employer within the last 2 years



A Rating Authority (e.g. Land / Water / Service Rates)

4. Supplementary Documents

NAME verified from any other identification (Note: More than one document may be

counted, but points scored from a particular source may only be counted once)

Available Points per Item

Points

Scored



Telephone Account



Credit Card / Medicare Card / Private Health Insurance Card

NAME and DATE OF BIRTH verified from one of the following:



Records of a Primary / Secondary / Tertiary educational institution attended within last 10 years



Records of professional or trade association membership

5. Special Provisions only to be used if 100 point check above cannot be met

Points

Scored



For recent arrivals in Australia (6 weeks or less – proof of arrival date required) current

passport

N.B The full 100 point check is required when the applicant has been in Australia for longer than 6 weeks.

100

6. Total Points

Total Points

Scored



Points must equal or exceed a total of 100 points

7. Manager Declaration

<Date>

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY SOCIAL WORK ABN 63 968 822 144

THE SALVATION ARMY AUSTRALIA EASTERN TERRITORY GENERAL WORK ABN 81 404 0247 599

NATIONAL POLICE CHECKING SERVICE

GENERAL INFORMATION

This Form is used by The Salvation Army (New South Wales) Property Trust and The Salvation Army (Queensland) Property Trust (“The

Salvation Army (Australia Eastern Territory)”) as part of the assessment process to determine whether a person is suitable for

employment or other engagement for work with The Salvation Army Australia Eastern Territory.

Unless statutory obligations require otherwise, the information provided on this Form will not be used without your prior consent for any

purpose other than in relation to the assessment of your suitability. You may be required to complete another consent form in the future in

relation to employment in other positions within The Salvation Army (Australia Eastern Territory).

NATIONAL CRIMINAL HISTORY CHECK

A national Criminal history record check is an integral part of the assessment of your suitability

Information extracted from this Form will be forwarded to the CrimTrac Agency, and other Australian police services

or other law

enforcement agencies for checking action. By signing the Form you are providing your consent to these agencies:

a) disclosing criminal history information that pertains to you from their own records to The Salvation Army (Australia Eastern Territory);

and/or

b) accessing their records to obtain criminal history information that in turn will be disclosed to The Salvation Army (Australia Eastern

Territory).

Such criminal history information may include outstanding charges, and criminal convictions/findings of guilt recorded against you that may

be disclosed according to the laws of the relevant jurisdiction and, in the absence of any laws governing the release of that information,

according to the relevant jurisdiction's information release policy.

It is usual practice for an applicant’s personal information to be disclosed to Australian police services for them to use for their respective

law enforcement purposes including the investigation of any outstanding criminal offences.

SPENT CONVICTIONS SCHEMES

New South Wales

In New South Wales the Criminal Records Act 1991 (NSW) governs the effect of a person’s conviction for a relatively minor offence if the

person completes a period of crime-free behaviour, and makes provision with respect to quashed convictions and pardons.

A “quashed” conviction is a conviction that has been set aside by the Court. A “pardon” means a free and absolute pardon that has been

granted to a person because he/she was wrongly convicted of a Commonwealth, Territory, State or foreign offence.

In relation to NSW convictions, a conviction generally becomes a “spent conviction” if a person has had a ten year crime-free period from

the date of the conviction. However, certain convictions may not become spent convictions, and therefore need to be disclosed in the

attached form. These include:

 where a prison sentence of more than 6 months has been imposed (periodic or home detention is not considered a prison

sentence);

 convictions against companies and other corporate bodies;

 sexual offences pursuant to the Criminal Records Act 1991; and

 convictions prescribed by the regulations.

Other Australian Police Services

Where a criminal history record with another Australian police service has been obtained, any jurisdictional legislation (and/or release

policy) affecting the disclosure of these records will be applied before that record is released. Under various pieces of Commonwealth,

State and Territory legislation a person has the right, in particular circumstances or for a particular purpose, to not disclose certain

convictions/findings of guilt over a certain age. Such convictions (widely referred to as “spent” or “rehabilitated” convictions) will not be

released unless there is an applicable exemption or exclusion from such legislation and/release policy. Please contact individual police

services directly for further information about their release policies and any legislation that affects them.

PROVISION OF FALSE OR MISLEADING INFORMATION

You are asked to certify that the personal information you have provided on this form is correct. If it is subsequently discovered,

for example as a result of a check of police records, that you have provided false or misleading information, you may be

assessed as unsuitable.

It is a serious offence to provide false or misleading information.

You should note that the existence of a record does not mean that you will be assessed automatically as being unsuitable. Each

case will be assessed on its merit, so it is in your interests to provide full and frank details in the form.

Australian Federal Police, New South Wales Police Force, Victoria Police, Queensland Police Service, South Australia Police, Western Australia Police,

Tasmania Police, Northern Territory Police Force.