Main2019-03-04T07:01:23+00:00

Screening and Licensing Branch
Police Check, Informed Consent Form
For Ready Check

Personal Details of Applicant

This section of the Form is to be completed by the Applicant


Title: MissMsMrsMrDrProfessorOther (Please Specify)
Family Name:
Given Name:
Preferred Name:
Previous Name(s): (include ALL other names, i.e maiden name, changes by deed poll, alias names)

Family Name:
Given Name(s):
Family Name:
Given Name(s):
Family Name:
Given Name(s):
Gender: MaleFemale
Date of Birth:
Town of Birth:
State of Birth:
Country of Birth:
Passport number:
Country of Issue:
Diver's License number:
State/Territory of Issue:
Are you (or do you identify as) Aboriginal or Torres Strait Islander?: YesNo

Details of Applicant

APPLICANT’S ROLE INVOLVES: (Please indicate all relevant categories – can be more than one)
TITLE OF POSITION/ROLE HELD (OR TO BE HELD) BY THE APPLICANT:
Location:

Contact Details of Applicant

Current Residential Address:
Suburb/Town:
State:
Postcode:
Period of Residence:
From:
To:
Telephone (H):
(W):
(M):
Email Address:

Current Residential Address:
Suburb/Town:
State:
Postcode:
  • Please record all of you previous permanent residential addresses over the last five years in the space provided below (including overseas addresses). If there is insufficient space, please list them on a separate piece of paper and attach it to this document.
  • If you have been a citizen of permanent resident of country/countries other than Australia since turning 18 years of age you may be asked to provide further information or sign a statutory declaration about your criminal history during this period.
Previous Residential Address (1):
Suburb/Town:
State:
Postcode:
Period of Residence:
From:
To:

Previous Residential Address (2):
Suburb/Town:
State:
Postcode:
Period of Residence:
From:
To:

Consent to Obtain Personal Information

I hereby:
  1. Certify that I 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;
  2. Consent to ReadyCheack (Telads Australia Pty Ltd) disclosing personal information about me from this Form to the Australian Criminal Intelligence Commission (ACIC) and/or to Australian police services;
  3. Consent to:

Signature of Applicant
(Write your signature using your mouse on the white space above)

Date

Identification Confirmation

Please attach copies with the application
Category A Commencement of Identity Documents – ( one of these documents is required)
Full Australian Birth Certificate (not an extract)Current Australian Passport (not expired)Australian Visa. Current at time of entry to Australia as a resident or touristImmicard. Issued by immigration and Border protection.Certificate of Identity. Issued by Foreign Affairs and TradeDocument of Identity. Issue by Foreign Affairs and Trade.Certificate of evidence of resident status.
Number: Country of Issue Expiry Date
Category B Primary Use in the community document – (one of these documents is required)

Number: Country of Issue Expiry Date Govt Agency Education Facility
Category C Secondary Use in the Community Documents – (2 of these required)


Submit Identification (please ensure front and back of any ID are copied where required at least 2mb per file)