STAFF-IN-CONFIDENCE (WHEN COMPLETED)

NATIONAL POLICE CHECKING SERVICE (NPCS)

APPLICATION/CONSENT FORM
(ACCREDITED ORGANISATION - CUSTOMERS)
SECTION 1: PERSONAL INFORMATION - Use BLOCK LETTERS and black ink to complete this form. Mark check boxes with an (X)

Given Middle
Name Name

Surname

Date of
Gender: c Male
d
e
f
g c Female
d
e
f
g c Unknown
d
e
f
g Birth
/ /

Place of Birth (Required)

Suburb/Town State Country

Current Residential Address (Required)

Unit Street
Street Postcode
No. No.

Suburb State Country

Additional Details
If more room is required, list on separate sheet, sign and send the sheet with this application form. Additional sheet included? g
c Yes
d
e
f c No
d
e
f
g

Previous names (if applicable)

Given Middle
Name Name

Surname Type: g c Maiden

d
e
f c
d
e
f
g
Previous

5 Year Previous Address

Unit Street
Street Postcode
No. No.

Suburb State Country

5 Year Previous Address

Unit Street
Street Postcode
No. No.

Suburb State Country

Contact Details

Phone Private Business Mobile

Email

Documents

Aust. Driver's Licence

State/Territory
No.

Firearms Licence No. State/Territory

Passport
Passport No.
Country
Passport Type c Private
d
e
f
g c Government
d
e
f
g c UN Refugee
d
e
f
g
 STAFF-IN-CONFIDENCE (WHEN COMPLETED)
NATIONAL POLICE CHECKING SERVICE (NPCS)
APPLICATION/CONSENT FORM
(ACCREDITED ORGANISATION - CUSTOMERS)
SECTION 2: PROOF OF IDENTITY
When applying for a national police history check it is necessary for you to verify your identity in line with Australia’s National Identity Security Strategy.
To achieve this, you must at a minimum:

provide four (4) documents

all four (4) documents cannot be drawn from a single category
it is strongly recommended to try and use a document from each category

In combination, your documents must include your full name, date of birth, and a photograph
Commencement of identity documents
(a) full Australian birth certificate (not an extract or birth card)
(b) current Australian passport (not expired)
(c) Australian visa current at time of entry to Australia as a resident or tourist
(d) ImmiCard issued by Department of Home Affairs (previously the Department of Immigration and Border Protection) that enables the cardholder to prove their visa
and/or migration status and enroll in services
(e) certificate of identity issued by Department of Foreign Affairs and Trade (DFAT) to refugees and non-Australian citizens for entry to Australia
(f) document of identity issued by DFAT to Australian citizens or persons who have the nationality of a Commonwealth country for travel purposes
(g) certificate of evidence of resident status.
Primary use in the community documents
(a) current Australian drivers licence, learner permit or provisional licence issued by a state or territory, showing a signature and/or photo and the same name as
claimed
(b) Australian marriage certificate issued by a state or territory (church or celebrant-issued certificates are not accepted)
(c) current passport issued by a country other than Australia with a valid entry stamp or visa
(d) current proof of age or photo identity card issued by an Australian Government agency in the name of the applicant, with a signature and photo
(e) current shooters or firearms licence showing a signature and photo (not minor or junior permit or licence)
(f) for persons under 18 years of age with no other Primary Use in Community Documents, a current student identification card with a signature or photo.
Secondary use in the community documents

(a) certificate of identity issued by DFAT

(b) document of identity issued by DFAT
(c) convention travel document secondary (United Nations) issued by DFAT
(d) foreign government issued documents (for example, drivers licence)
(e) Medicare card
(f) enrolment with the Australian Electoral Commission
(g) security guard or crowd control photo licence
(h) evidence of right to an Australian government benefit (Centrelink or Veterans’ Affairs)
(i) consular photo identity card issued by DFAT
(j) photo identity card issued to an officer by a police force
(k) photo identity card issued by the Australian Defence Force
(l) photo identity card issued by the Australian Government or a state or territory government
(m) Aviation Security Identification Card
(n) Maritime Security Identification card
(o) credit reference check
(q) Australian secondary student photo identity document
(r) certified academic transcript from an Australian university
(s) trusted referees report
(t) bank card
(u) credit card

Please note that it is an Australian Criminal Intelligence Commission (ACIC) requirement of fit2work to link identity documents to you as an individual as a part of the
application process. To do so, it may be necessary to require additional documents to be uploaded as well as make all enquiries necessary to satisfy this requirement.

fit2work is required, and will report any suspicion of identity fraud detected on the platform to the relevant Australian Police Service and the ACIC.

Applications must be made by the individual for whom the check is sought, or somebody authorised to make the application on the applicant’s behalf (e.g. parent, legal
guardian or authorised agent). The link between identity documents and the applicant must still be satisfied by fit2work.

Applicants are only required to provide identity documents for their primary name, not for any previously known names.

If identity documents are provided using a former name (e.g. maiden name) evidence of the name change must be provided in addition to the minimum four (4)
identity documents.

If you have a legitimate reason prohibiting you from meeting these verification of identity requirements, special provisions can be used to verify your identity.

If this applies to you please go to [Link] , or click here.

 STAFF-IN-CONFIDENCE (WHEN COMPLETED)
NATIONAL POLICE CHECKING SERVICE (NPCS)
APPLICATION/CONSENT FORM
(ACCREDITED ORGANISATION - CUSTOMERS)
SECTION 3: ACCREDITED ORGANISATION DETAILS

Accredited Organisation Equifax Australasia Workforce Solutions Pty Limited t/a [Link]
ABN: 86 080 799 720

SECTION 4: AUTHORISATION TO DISCLOSE PERSONAL INFORMATION

Is the result of the national police history check to be forwarded/disclosed only to the accredited agency named in Section 3 above? g
c Yes
d
e
f b No
c
d
e
f
g
If No: I authorise the result of the national police history check to be forwarded/disclosed to the following employer/organisation:

Employer/Organisation Third Sector Australia Limited

ABN: 54213576984

SECTION 5: PURPOSE OF THE NATIONAL POLICE HISTORY CHECK

Provide details of relevant position/entitlement, place of work and whether you have contact with vulnerable groups. e.g. Client Services Officer in a call centre,
Janitor at a school, Nurse in aged care facility with direct care of disabled & aged persons or Flight Attendant with direct care of children). />

Purpose/Description of Duties __________________________________________________________________

 STAFF-IN-CONFIDENCE (WHEN COMPLETED)
NATIONAL POLICE CHECKING SERVICE (NPCS)
APPLICATION/CONSENT FORM
(ACCREDITED ORGANISATION - CUSTOMERS)
SECTION 6: CONSENT TO OBTAIN PERSONAL INFORMATION
National Police History Check

I, __________________________________________________________ __________________________________________________________ hereby:

Given Names (Current) Family Name(Current)

1. acknowledge that I have read the General 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 national police history check for which I am applying may be in a category for which exclusions from Spent Convictions legislation may apply;
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 the Accredited Organisation named in Section 3 of this form is collecting information in this Form to provide to the Australian Criminal Intelligence
Commission (ACIC) and the Australian police agencies;
6. consent to:
i. the Australian Criminal Intelligence Commission (ACIC) disclosing personal information about me to the Australian police agencies;
ii. the Australian police agencies disclosing to the Australian Criminal Intelligence Commission (ACIC), 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;
iii. the Australian Criminal Intelligence Commission (ACIC) providing the information disclosed by the Australian police agencies to the Accredited Organisation
named in Section 3 of this form, in accordance with the laws of the Commonwealth; and
iv. where applicable, the Accredited Organisation named in Section 3 of this form disclosing to the employer/organisation named in Section 4 of this form personal
information about me to assess my suitability in relation to my employment/entitlement; and
7. acknowledge that any information provided by me on this Form, relates specifically to the purpose identified in Section 5 of this form;
8. acknowledge that any information provided by the Australian police agencies or the Australian Criminal Intelligence Commission (ACIC), relates specifically to the
purpose identified in Section 5 of this form;
9. Acknowledge that any information sent, by mail or electronically, in relation to this form, including any identity documents, is sent at my own risk and I am aware of the
consequences of these methods of lodgement;
10. acknowledge that personal information that I provide in this Form may be disclosed to the Accredited Organisation named in Section 3 of this form (including contractors
or related bodies corporate) located in Australia or overseas for administrative purposes;
11. acknowledge that 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;
12. understand that I may dispute the Police History Information contained within my National Police History Check by contacting the Accredited Organisation in the first
instance;
13. acknowledge that the Accredited Organisation is Equifax Australasia Workforce Solutions Pty Limited t/a [Link] and the Privacy Officer can be contacted on
1300 525 525 or via mail to Equifax Australasia Workforce Solutions Pty Limited Privacy Officer, 119 Cecil St South Melbourne VIC 3025; and
14. understand that the ACIC Privacy Officer can be contacted on (02) 6268 7000 or privacy@[Link] or GPO Box 1573 Canberra City ACT 2601.

Note: The information you provide on this form, and which the Australian Criminal Intelligence Commission (ACIC) provides to the Accredited
Organisation named in Section 3 of this form, on receipt of the form, will be used only for the purpose stated above unless statutory obligations
require otherwise.

Applicant's Signature: ___________________________________________________ Date: ___ / ___ / _______

Parent/Guardian Consent - If you are under 18 years of age provide consent below from a parent /guardian.

Parent/Guardian Parent/Guardian name

_______________________________ Date: ___/___/______ __________________________________________
Signature printed in full

Office Use

Check Urgency: c Normal g

d
e
f
g c Urgent
d
e
f Type of Check: c Employee g
d
e
f
g c Volunteer
d
e
f

Vulnerable People check c Yes g

d
e
f
g c No
d
e
f
(Select YES for Vulnerable People clearance if the applicant’s employment or volunteer role involves care for children, aged persons, persons with a physical or intellectual
disability or mental illness)

Applicant Role: __________________________________________ Other Info: __________________________________________

Department: __________________________________________ Supervisor: __________________________________________

 STAFF-IN-CONFIDENCE (WHEN COMPLETED)
NATIONAL POLICE CHECKING SERVICE (NPCS)
APPLICATION/CONSENT FORM
(ACCREDITED ORGANISATION - CUSTOMERS)
GENERAL INFORMATION

GENERAL INFORMATION Queensland

This Form is used as part of the assessment process to determine whether a person Under Queensland’s Criminal Law (Rehabilitation of Offenders) Act 1986 a conviction
is suitable for employment or other engagement for work or other entitlements. automatically becomes spent upon completion of the prescribed (rehabilitation) period.
Unless statutory obligations require otherwise, the information provided on this Form This period is:
will not be used without your prior consent for any purpose other than in relation to (i) 10 years for indictable offences where the offender was an adult at the time of
the assessment of your suitability. You may be required to complete another consent conviction; and
form in the future in relation to employment in other positions. (ii) 5 years for other (summary offences or where the offender was a juvenile).
Where a person is convicted of a subsequent offence (an offence other than a simple or
NATIONAL POLICE HISTORY CHECK regulatory offence) during the rehabilitation period, the period runs from the date of the
subsequent conviction.
A national police history check is an integral part of the assessment of your suitability. Convictions where the offender is sentenced to more than 30 months imprisonment
You should note that the existence of a record does not mean that you will be (whether or not that sentence is suspended) are excluded from the regime.
assessed automatically as being unsuitable. Each case will be assessed on its merit, Once the rehabilitation period has expired, it is lawful for a person to deny (including
so it is in your interest to provide full and frank details in the Form. under oath) that the person has been convicted of the offence, and the conviction must
Information extracted from this Form will be forwarded to the Australian Criminal be disregarded for occupational licensing purposes (subject to certain exceptions, see
Intelligence Commission (ACIC) and other Australian police agencies 1 for checking below). It is unlawful for any person to disclose the conviction unless:
action. By signing this Form you are consenting to these agencies accessing their (i) the convicted person consents;
records to obtain and disclose police history information that relates to you to: (ii) the Minister has granted a permit authorising disclosure (where there is a legitimate
a) the Accredited Agency named in Section 3 above; and and sufficient purpose for disclosing);
b) where applicable the employer/organisation named in Section 4 above. (iii) the disclosure is subject to an exemption.
Police history information may include outstanding charges, and criminal
convictions/findings of guilt recorded against you that may be disclosed according to Victoria Police
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 For the purposes of employment, voluntary work or occupational licensing/registration,
policy. police may restrict the release of a person’s police record according to the Victoria
Police “Information Release Policy”. If you have a police record the “Information
SPENT CONVICTIONS SCHEMES Release Policy” may take into account the age of the police record and the purpose for
which the information is being released. If 10 years have elapsed since you were last
The following information is provided as general guidance and is not exhaustive. found guilty of an offence, police will, in most instances, advise that you have no
The aim of Spent Convictions legislation2 is to prevent discrimination on the basis of disclosable court outcomes. However, a record over 10 years may be released if:
certain previous convictions. Spent convictions legislation limits the use and (i) it includes a term of imprisonment longer than 30 months;
disclosure of older, less serious convictions and findings of guilt. (ii) it includes a serious, violent or sexual offence and the check is for the purpose of
Spent convictions of specific offences will be released where the check is required for working with children, elderly people or disabled people;
certain purposes regardless of how old the convictions are. Each Australian police (iii) it is in the interests of crime prevention or public safety.
agency will apply the relevant Spent Convictions legislation/information release policy Findings of guilt without conviction and good behaviour bonds may be released. Recent
prior to disclosure. charges or outstanding matters under investigation that have not yet gone to court may
If further information or clarification is required please contact the individual police also be released.
agencies directly for further information about their release policies and any
legislation that affects them. New South Wales

Commonwealth 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
Part VIIC of the Crimes Act 1914 (Cth) deals with aspects of the collection, use and crime-free behaviour, and makes provision with respect to quashed convictions and
disclosure of old conviction information. The main element of this law is a “Spent pardons.
Convictions Scheme”. The aim of the Scheme is to prevent discrimination on the A “quashed” conviction is a conviction that has been set aside by the Court. A “pardon”
basis of certain previous convictions, once a waiting period (usually 10 years) has means a free and absolute pardon that has been granted to a person because he/she
passed and provided the individual has not re-offended during this period. The was wrongly convicted of a Commonwealth, Territory, State or foreign offence.
Scheme also covers situations where an individual has had a conviction “quashed” or In relation to NSW convictions, a conviction generally becomes a “spent conviction” if a
has been “pardoned”. person has had a 10 year crime-free period from the date of the conviction. However,
A “spent conviction” is a conviction of a Commonwealth, Territory, State or foreign certain convictions may not become spent. These include:
offence that satisfies all of the following conditions: (i) where a prison sentence of more than 6 months has been imposed (periodic or home
i). it is 10 years since the date of the conviction (or 5 years for juvenile offenders); detention is not considered a prison sentence);
AND (ii) convictions against companies and other corporate bodies; (iii) sexual offences
ii). the individual was not sentenced to imprisonment or was not sentenced to pursuant to the Criminal Records Act 1991; and
imprisonment for more than 30 months; AND (iv) convictions prescribed by the Regulations
iii). the individual has not re-offended during the 10 years (5 years for juvenile
offenders) waiting period; AND
iv). a statutory or prescribed exclusion does not apply. (A full list of exclusions is 1Australian
available from the Office of the Australian Information Commissioner). Federal Police, The New South Wales Police Force, Victoria Police,
The law affects Commonwealth authorities in the following ways: Queensland Police Service, South Australia Police, Western Australia Police, Tasmania
i). a person with a conviction protected by Part VIIC does not have to disclose that Police Service, Northern Territory Police Force.
conviction to any person, including a Commonwealth authority, unless an exclusion 2Applicable spent conviction legislation, as amended from time to time.
applies;
ii). Commonwealth authorities are prohibited from accessing, disclosing or taking into
account spent convictions of Commonwealth offences.
Part VIIC and Crimes Regulations 1990 provide for “statutory” or “regulatory”
exclusions that will prevent certain Commonwealth convictions from being spent in
certain circumstances.
 STAFF-IN-CONFIDENCE (WHEN COMPLETED)
NATIONAL POLICE CHECKING SERVICE (NPCS)
APPLICATION/CONSENT FORM

BACKGROUND EMPLOYMENT CHECKS

GENERAL INFORMATION (continued)

Tasmania Australian Capital Territory

Under the Annulled Convictions Act 2003 (Tas) a conviction is annulled upon Generally, under the Spent Convictions Act 2000 (ACT), a conviction becomes spent
completion of the prescribed period of good behaviour. This period is: automatically at the completion of the prescribed (crime-free) period. This period is:
(i) 10 years where the offender was an adult at the time of conviction; or (i) 10 years for convictions recorded as an adult; or
(ii) 5 years where the offender was a juvenile at the time of conviction. (ii) 5 years for convictions recorded as a juvenile.
A person is taken to be of good behaviour for the required period if, during that The period begins to run from the date a sentence of imprisonment is completed, or,
period, he or she is not convicted of an offence punishable by a term of imprisonment. where no sentence of imprisonment is imposed, from the date of conviction. A person
If the person is so convicted, the qualifying period (for the original offence) starts to must not be subject to a control order or convicted of an offence punishable by
run from the date of the subsequent conviction. A subsequent traffic conviction is only imprisonment during this period. If a person is convicted of an offence, which was
taken into account for prior traffic offences (except more serious traffic offences which committed in the crime-free period, but the conviction is not incurred until after the
cause injury or death). crime-free period, the spent conviction may be revived and will not become spent again
Only “minor” convictions can become annulled. A minor conviction is a conviction until the offender has achieved the relevant crime-free period in respect of the later
other than one for which a sentence of imprisonment of more than 6 months is offence.
imposed, a conviction for a sexual offence or a prescribed conviction. A minor The effect of conviction becoming spent is that:
conviction is also annulled if the offence ceases to be an offence. (i) the convicted person is not required to disclose any information concerning the spent
Once an offence is annulled the convicted person is not required to disclose any conviction;
information concerning the spent conviction. Any question concerning criminal history (ii) any question concerning criminal history is taken only to apply to unspent
is taken only to apply to unspent convictions, and references in Acts or statutory convictions;
instruments to convictions or character or fitness do not include spent convictions. An (iii) references in Acts or statutory instruments to convictions or character or fitness
annulled conviction or the non-disclosure of the annulled conviction is not grounds for does not include spent convictions, and it is an offence to disclose information
refusing the person any appointment, post, status or privilege or revoking any regarding spent convictions;
appointment, post, status or privilege. (iv) it is unlawful for a person who has access to a person’s criminal record held by a
(i) a person is not required to disclose the existence of the conviction; public authority to disclose a spent conviction;
(ii) questions relating to convictions and a person’s criminal record will be taken only (v) it is unlawful for a person to fraudulently or dishonestly obtains information about a
to apply to unspent convictions; spent conviction from records kept by a public authority.
(iii) it is unlawful for another person to disclose the existence of a spent conviction
except as authorised by the Act; Northern Territory
(iv) spent convictions are not to be taken account in making decisions about the
convicted person’s character or fitness. Under the Criminal Records (Spent Convictions) Act 1992 (NT), a conviction becomes
spent automatically (in the case of an adult or juvenile offender convicted in a Juvenile
South Australia Court) and by application to the Police Commissioner (in the case of a juvenile
convicted in an adult court) upon completion of the prescribed period. The prescribed
Release of information on a National Police Check is governed by the South period is:
Australian Spent Convictions Act 2009. It is an offence to release information (i) 10 years for offences committed while an adult; and
regarding the convictions of a person if those convictions are deemed to be ‘spent’ (ii) 5 years for offences committed as a juvenile
under the Act. The period starts on completion of any sentence of imprisonment. A subsequent traffic
A spent conviction is one that cannot be disclosed or taken into consideration for any conviction is only taken into account for prior traffic offences (except more serious traffic
purpose. Eligible convictions become spent following a 10-year conviction and proven offences which cause injury or death). Once a conviction becomes spent:
offence-free period for adults, and a 5-year conviction and proven offence-free period (i) a person is not required to disclose the existence of the conviction;
for juveniles. (ii) questions relating to convictions and a person’s criminal record will be taken only to
The Act defines a conviction as: apply to unspent convictions;
i). a formal finding of guilt by a Court; (iii) it is unlawful for another person to disclose the existence of a spent conviction
ii). a finding by a Court that an offence has been proved. except as authorised by the Act;
Certain convictions can never be spent. These include but are not limited to: (iv) spent convictions are not to be taken account in making decisions about the
i). convictions of sex offences; convicted person’s character or fitness.
ii). convictions where a sentence is imposed of more than 12 months imprisonment
for an adult, or 24 months imprisonment for a juvenile. PROVISION OF FALSE OR MISLEADING INFORMATION
Schedule 1 of the Act sets out a number of exceptions to the rule where spent
convictions can be released. Some examples of this include: You are asked to certify that the personal information you have provided on this form is
i). the care of children; correct. If it is subsequently discovered, for example as a result of a check of police
ii). the care of vulnerable people (including the aged and persons with a disability, records, that you have provided false or misleading information, you may be assessed
illness or impairment); as unsuitable.
iii). activities associated with statutory character tests for licensing It is a serious offence to provide false or misleading information
Interstate offences are released in accordance with that State or Territory's spent
conviction / rehabilitation legislation and policy. Intelligence-type information is not
released.

Western Australia
Under the provisions of Section 7(1) of the Spent Convictions Act 1988 (WA) only
“lesser convictions” can be spent by Western Australia Police, after a time period of
10 years plus any term of imprisonment that may have been imposed. A lesser
conviction is one for which imprisonment of 12 months or less, or a fine of less than
$15,000 was imposed.
All other convictions, such as “serious convictions” applicable under Section 6 of the
Act can only be spent by applying to the District Court. At the time of sentencing, the
Court may make a “spent conviction order” under the Sentencing Act 1995 (WA) that
the conviction is a spent conviction for the purposes of the Spent Convictions Act
1988 (WA).