Fillable Printable Working with Children Check Notification of Change of Personal Details Form

Working with Children Check Notification of Change of Personal Details Form

Working with Children Check

Notification of Change of

Personal Details Form

Update my address Complete Section 1,2 and 5

Update my contact phone numbers Complete Section 1,3 and 5

Update my employer or organisation details Complete Section 1,4 and 5

Section 1 Your Details

Title (eg. Mr, Ms, Mrs, Miss, Dr)

Family Name (Surname)

Gender:

Male

Female

First Name and Middle Name/s

Date of Birth:

M M Y Y Y Y

Current Card/Application Receipt Number

Section 2 Current Address

To advise of your change of personal details please complete this notification form and post it to:

Working with Children Check Unit

GPO Box 1915

MELBOURNE VIC 3001

The information you provide on this form will be used to update your record.

If you have changed your name or need a replacement card please use the Replacement Card Application Form which is

available for printing from the Working with Children (WWC) Check web site at www.justice.vic.gov.au/workingwithchildren)

or by contacting the WWC Check Information Line on 1300 652 879.

Privacy Statement

The Department of Justice is bound by Victorian privacy laws (Information Privacy Act 2000 and Health Records Act

2001). The personal information you provide will be used to update your record and to monitor your continuing suitability

to work with children. This information may also be disclosed to other agencies, including police services in Australia and

the Victorian Institute of Teaching, as provided for in the Working with Children Act 2005. If you do not provide all relevant

personal details, we may not be able to process your request. For further information about accessing your personal

information or our full privacy statement please refer to the website at www.justice.vic.gov.au/workingwithchildren or

contact the Information Line on 1300 652 879.

Please print in black pen within the boxes in block letters.

WWCCU Change Personal Details Form July 06 Page 1 of 2

Section 3 Current Contact Phone Numbers

Mobile Contact Number

Home Contact Phone Number

Work Contact Phone Number

Reason for Notification

I would like to (cross all that apply)

Residential Address

Suburb/Locality

State Postcode

Postal Address (if different to above)

Suburb/Locality

State Postcode

Section 5 Declaration

If updating your employer details above, please advise below all of the types of child related work in which

you currently work or volunteer or intend to work or volunteer and your status ie. volunteer or employee

(self-employed) (the Table of Child-Related Work Areas is available at the Working with Children Check Website

www.justice.vic.gov.au/workingwithchildren)

Section 4 Current Employer/Volunteer Organisation Details

Please list all organisations with whom you are currently undertaking child-related work. This will update your record

and any previous organisations you have listed will be deleted.

OFFICE USE ONLY

Date received

Incomplete - date returned

M M Y Y Y Y

Date entered

M M Y Y Y Y

Entered by

WWCCU Change Personal Details Form July 06 Page 2 of 2

It is a criminal offence under section 39 of the Working with Children Act 2005 to provide false or misleading

information in relation to an application for a Working with Children Check.

I declare that the information I have provided on this form is true and correct.

Code Number Volunteer Employee

X X

Code Number Volunteer Employee

X X

Date

M M Y Y Y Y

➧

Your

signature

Street Address

Suburb/Locality

Employer/Volunteer Organisation HR Manager Contact Phone Number

Name of Other Organisation

State Postcode

Street Address

Suburb/Locality

Employer/Volunteer Organisation HR Manager Contact Phone Number

Name of Other Organisation

State Postcode

Street Address

Suburb/Locality

Employer/Volunteer Organisation HR Manager Contact Phone Number

Name of Other Organisation

State Postcode