Working with Children Check
Summary – Interstate application requirements
Next steps
1. Print the application 4. Have your documents certified
summary Ask a certifying officer, such as a Justice of
Applicants for an Employee Check the Peace, to:
must also print the payment form. • certify the copies of your documents and one
of the passport size photos.
2. Prepare your proof of
identity documents • complete their declaration on the application
summary.
• You must provide three identity
documents that together identify you
by your full name, date of birth and 5. Ready to lodge your application?
photo. You can use any one of the You need to mail the following to the
following combinations: department:
1. One primary document and two
secondary documents Your completed application
summary
2. Two primary documents and one
secondary document, or Copies of your identity documents
3. Three primary documents. certified as true copies of the
originals
• One acceptable combination is an
Two passport-size photos, one
Australian driver’s licence, a Medicare
certified on the back
card, and a credit or account card*.
You could also use an Australian A completed payment form, if you
birth certificate, a tertiary student ID are applying for an Employee
card, and a proof of age card. You Check
cannot use two of the same type of
identity documents to make up the
three documents (for example, two 6. Mail your application to:
different credit cards). Working with Children Check Victoria
Department of Government Services
• Photocopy your documents, and take GPO Box 1915
them, along with the originals, to a Melbourne VIC 3001
certifying officer.
We will email you an acknowledgement once
3. Supply photos we receive your application.
• You must provide two passport-size For further information, refer to the Interstate
photos that meet the requirements applicant information guide
listed on the website. For further If you require assistance, please call
details, refer to the Interstate applicant 1300 652 879 during business hours.
information guide. One photo must be
certified on the back by the certifying
officer stating the photo is a true
likeness of you.
* American Express and Diners Club cards are not accepted.
Application number: 2821082A
Working with Children Check Victoria
Working with Children Check - Employee Application summary
Important instructions: DO NOT make changes to this document, as it will not be accepted if it has been
amended.
We MUST receive this document before 29/07/2023 . An Employee (E) card fee is $128.20.
Name : Haimin WANG
Date of Birth: 01/06/1995
Current residential address: BA029 Building 955, 100 Clyde Road
Berwick VIC 3806
Current postal address: BA029 Building 955, 100 Clyde Road
Berwick VIC 3806
Previous names:
Contact phone numbers: Mobile: 0466268598
Applicant’s photo and certifying officer's declaration
I confirm and declare that I have: Secure photo face up
• certified the photo as a true likeness of the
applicant.
DO NOT FOLD
• certified the copies of the applicant's proof
THROUGH PHOTO
of identity documentation, confirmed they are
current, and that they match the name and
date of birth on the application.
Certifying officer's name
Certifying officer's signature
Date certified
D D M M Y Y Y Y
Working with Children Check Victoria
Payment form
Haimin WANG
Application number: 2821082A
Please complete this form and attach to your completed application form. The non-refundable fee for an
Employee application is $128.20.
Privacy statement
We are bound by Victorian privacy laws ( Privacy and Data Protection Act 2014 and Health Records Act
2001 ). For details go to our website: [Link].
Payment options
Please select your preferred payment option.
Please note that cash payments, personal and business cheques cannot be accepted.
MasterCard Visa Bank cheque Money order
American Express and Diners cards are not accepted Payable to: Department of Government Services Victoria
Credit card authorisation
Credit card number Expiry date
M M Y Y
NOTE: Your credit card details are not retained after your payment is processed
Name on credit card
Cardholder's signature
Date Amount
D D M M Y Y Y Y $
Office use only
Date payment taken Receipt Number