FormResponseUUID

 PRICES & CHECK TYPES

STANDARD CHECK	$50.00 (GST INC)
VOLUNTEER CHECK	$23.00 (GST INC)

IMPORTANT!

  Please click on the buttons below and read the information provided before proceeding with filling out this form.

        INFORMATION ABOUT THIS FORM              IDENTITY DOCUMENT GUIDE                  

CONTACT DETAILS

You can contact the accredited body for more information on the nationally coordinated criminal history check process, how your information is handled and how you can dispute your result through the accredited body.

Accredited Body

Contact DetailsAddress: P.O Box 1106 Hamlyn Heights VIC 3215 Email: admin@elitescreeningaustralia.com.au Phone: 1300 959 214

Let's get started with your current FULL NAME

All known names:

You must disclose all names you have been known by through out your life, including your full legal name, name before marriage (maiden name), and other previous names and/or alias names. All names that you submit as part of your nationally coordinated criminal history check, will appear on the check result. If you are concerned about the disclosure of previous name, please contact the accredited body. 

With each additional name you provide, you must include your family name, first given names and other given names (ifapplicable). 

Example: When Lucianne was born, she was given the first name Lucianne,second given name Jane and surname of Jones. When she was married, she changed her surname to Smith. Lucianne commonly uses the name Lucy when introducing herself in the community. 

As such, Lucianne has four known names—her current name, maiden name, the alias name she used before she got married andthe alias name she uses now. Lucianne needs to provide all fournames when completing this form, as follows: 

Current name: Smith, Lucianne Jane        Maiden name: Jones, Lucianne Jane 

Alias name: Smith, Lucy Jane                      Previous name: Jones, Lucy Jane

Single Names 

A single name is where your name comprises of:

 •only one word; or 

•several words not using Western naming conventions (as per your commencement document). 

Example: 

• Angel - with no other name 

• Mohammed Rasheed Khan – consists of several words that are not documented with a specific first name, middle name, and family name.

First Name: (legal name)

Other Name/s:

Surname:

Name Type: *

Birth/MaidenMarriedAliasOther

Single Name:

What is your CONTACT phone number?

Contact Phone Number: *

What is the check type?

Please read this before answering the following question.

You may request a volunteer check if you:

(a) will hold a position or perform a role on a voluntary basis for charitable purposes which have a public benefit where you willnot be an employee or contractor and will not be entitled to anysalary or other entitlements associated with the position or role,other than payment of out of pocket expenses; or

(b )are a student undertaking a compulsory unpaid vocational placement as part of a training course requirement from anAustralian-based educational institution.

The Volunteer check type must not be selected for the Australian Government’s Work for the Dole Scheme. 

You must be able to validate the Not-for-Profit organisation and the volunteer position to support your selection of the volunteer type.

Please choose your check type *Standard $50.00Volunteer $23.00

What is the PURPOSE of the CHECK you need?

CHECK CATEGORIES/PURPOSE

The purpose for your nationally coordinated criminal history check helps determine what police information is disclosed on your result

• Employment – Paid or unpaid work. Unpaid work is when you are not paid however an employment type relationship exists, for example an internship or work experience. 

• Probity – Representing yourself as a “fit and proper” person, such as, for membership and tenancy applications
  

• Licence - Undertaking licensed or regulatory activities, such as applying for a gaming licence or for registration as a greyhound trainer.

• Commonwealth - Engaged by the Commonwealth but residing outside of the ACT, for example being engaged by Services Australia but residing in WA.

What reason do you need this police check for: *Choose oneEmploymentProbityLicenceCommonwealth

Please provide clear details for your CHECK TYPE...

Please read this before answering the following question.

For question B2, provide the following information: Note: 

Acronyms must not be used. 

• Position title, occupation, volunteer role, entitlement beingsought or licence type. 

• Proposed place of work (name of employer or organisation providing the entitlement). 

• Location of the role (town and state/territory).   
  

Example: Case worker, Department of Human Services, Canberra, Australian Capital Territory 

Example: Volunteer in canteen, St Bebes, Canberra, Australian Capital Territory

Occupation/Position Title, volunteer role, entitlement or licence type *

What is your proposed place of work?

Proposed place of work (name of organisation/ department) or requesting organisation or issuing authority *

Enter the name of the organisation where you will be working, 

Examples include:

• Coles

• Black & White Cabs

• YMCA

• Link SA

• Subway

Where is your WORK LOCATION?

Suburb/Location: *

State/Territory: *SelectACTNSWNTQLDSATASVICWA

PREVIOUS NAMES:

Do you have any other previous known names? *

YesNo

Tell us the details of all your PREVIOUS NAMES:

Previous First Given Name(s): *

Previous Other Given Name(s):

Previous Family Name: *

Name Type: *

Birth/MaidenMarriedAliasPrevious

Do you have any other previous known names? *

YesNo

Previous First Given Name(s): *

Previous Other Given Name(s):

Previous Family Name: *

Name Type: *

Birth/MaidenMarriedAliasPrevious

Do you have any other previous known names? *

YesNo

Previous First Given Name(s): *

Previous Other Given Name(s):

Previous Family Name: *

Name Type: *

Birth/MaidenMarriedAliasPrevious

Do you have any other previous known names? *

YesNo

Previous First Given Name(s): *

Previous Other Given Name(s):

Previous Family Name: *

Name Type: *

Birth/MaidenMarriedAliasPrevious

Do you have any other previous known names? *

YesNo

Previous First Given Name(s): *

Previous Other Given Name(s):

Previous Family Name: *

Name Type: *

Birth/MaidenMarriedAliasPrevious

Do you have any other previous known names? *

YesNo

If you have other previous names that you have not already entered above, please keep a record of these as we may need to ask you for this information.

If you have any concerns about this please contact us.

How do you identify your GENDER?

You must select the gender that best describes how you identify yourself within the community.  

The gender details that you submit as part of your nationally coordinated criminal history check, will be the gender that appears on the check result.

The ACIC’s processes are aligned with the Australian Government Guidelines on the Recognition of Sex and Gender. If these Guidelines affect you and you would like additional information specifically regarding this, please contact the ACIC directly at npcs@acic.gov.au

Gender *

MaleFemaleAnother Term

Please Specify

BIRTH DETAILS:

If you cannot provide all these details, contact the accredited body or its legal entity customer.

Are you 18 years old or over? *

YesNo

If you are under the age of 18,  you will need to have a parent or legal guardian provide their consent for you to perform a police check.

Your parent or legal guardian will need to sign their name in the 'Consent' section further along in this form.

PLEASE ENTER YOUR Date of Birth

Your date of birth: *

Where were you BORN?

Your Place of Birth (Suburb/town): *

Your Birth State/Territory: *SelectACTNSWNTQLDSATASVICWAOther

Your Birth Country: *SelectAfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

What is your CURRENT ADDRESS:

Current Residential Address *

Date you started living here: *

Is this your POSTAL address? *

YesNo

Postal Address: *

Date From:

Date To:

Provide your current and previous residential addresses for the past FIVE YEARS.

If you cannot provide full details, provide as much information as possible. If you are unsure how to complete this section contact the Elite Screening Australia - admin@elitescreeningaustralia.com.au or 1300959214

Do you have any other previous addresses in the last five years? *

YesNo

What are all your previous addresses in the past 5 years?

Previous residential address: *

Date you started living there: *

Date you stopped living there: *

Do you have any other previous addresses in the last five years? *

YesNo

Previous residential address: *

Date you started living there: *

Date you stopped living there: *

Do you have any previous addresses in the last five years? *

YesNo

Previous residential address: *

Date you started living there: *

Date you stopped living there: *

Do you have any previous addresses in the last five years? *

YesNo

Previous residential address: *

Date you started living there: *

Date you stopped living there: *

Do you have any previous addresses in the last five years? *

YesNo

Previous residential address: *

Date you started living there: *

Date you stopped living there: *

Do you have any previous addresses in the last five years? *

YesNo

If you have other previous addresses in the past 5 years that you have not already entered above, please keep a record of these as we may need to ask you for this information.

If you have any concerns about this please contact us.

INFORMED CONSENT

What is Informed Consent? 

Your Informed Consent is needed before an Accredited Body can request a Nationally Coordinated Criminal History Check for you. 

Your Informed Consent means you:

 • have read and understood the information provided in thisform about how your personal information and any police nformation relevant to you will be handled and disclosed 

• provide your permission for the Accredited Body to request a Nationally Coordinated Criminal History Check on your behalf 

• provide your permission for the Accredited Body to disclose your information to any organisation listed in D1 of this form

How do I provide my Informed Consent? 

An important aspect of providing Informed Consent is that you understand what you are consenting to. It is important that you read the consent statements in question D2 and, where required, get clarification from the Accredited Body or its Legal Entity Customer, to ensure complete understanding. You must then signand date this form at D2, to give your Informed Consent.

Important: Please read this information about question D1.

The Accredited Body is required to complete the details at D1 before providing the form to you. D1 provides the details of the organisations to whom your personal and police information will be disclosed to.In question D2, you will provide your Informed Consent for your personal and police information to be disclosed to the ACIC, Australian police agencies, law enforcement agencies, and any organisations detailed in question D1.

D1.... Organisations to whom the applicant’s personal and police information will be disclosed

Accredited Body Details

Accredited Body (legal name)

Preferred Contact Details

Address:

ABN

CONFIRM & PROVIDE YOUR SIGNATURE

Please read this before answering the following question.

You must provide your name, read each statement carefully and then print your name, sign and date to provide your informed consent.

Applicant’s consent to submit a nationally coordinated criminal history check

I, acknowledge that I/the applicant understand them information on this form.

acknowledge that the accredited body Elite Screening Australia iscollecting information in this form to provide to the Australian Criminal Intelligence Commission (ACIC) and police agencies, for a nationally coordinated criminal history check to be conducted for the purpose outlined in this form.

have fully and accurately completed this form, and the personal information I/the applicant, have provided relates to me/the applicant, and contains the full name and all names previously used by me/the applicant.

acknowledge that withholding and/or providing misleading or false information on this form and in any supplied identity documents is a Commonwealth offence and may lead to prosecution under the Criminal Code Act1995 (Cth).

acknowledge that personal information that I/the applicant provided on this form and on the supplied identity documents may be disclosed to the accredited body Elite Screening Australia of this form (including contractors, legal entity customers, related bodies or third parties named on this form in Australia or overseas,if applicable).

acknowledge that any information sent by mail or electronically, in relation to this form, including identity documents, is sent at my/the applicant’s risk and I/the applicant, am aware of the consequences of sending information in these ways.

acknowledge that any information sent by mail or electronically, in relation to this form, including identity documents, is sent at my/the applicant’s risk and I/the applicant, am aware of the consequences of sending information in these ways.

acknowledge that I/the applicant am aware that I/the applicant am providing consent for a nationally coordinated criminal history check to be conducted usingall personal information provided in this form andprovided in suppled identity documents.

acknowledge that it is usual practice for my/the applicant’s personal information and police informationto be used by police agencies and the ACIC for law enforcement, including purposes set out in the Australian Crime Commission Act 2002 (Cth).

understand and consent to police information relating to me/the applicant, being disclosed in accordance with the purpose identified in Section B of this form, and applicable legislation and information release policies (including spent convictions legislation described in Australian Government and state or territory legislation).

Give consent to:
a. the ACIC and police agencies using and disclosing my/the applicant’s personal information that I/the applicant, have provided in this form and personal information contained in my supplied identity documents to conduct a nationally coordinated criminal history check.

b. the ACIC disclosing the police information sourced from the police agencies to other approved bodies and Elite Screening Australia of this form.

c. the accredited body Elite Screening Australia of this form disclosing to the legal entity customer, third parties and any permitted offshore transfer arrangements, my/the applicant’s personal information and police information to assess my/the applicant’s suitabilityfor the purpose identified in this form.
*

Applicant:

Provide Full Name (including middle name) *

Signature: *

Clear

Date: *

PARENT/GUARDIAN CONSENT & SIGN

Parent or legal guardian 

(where the applicant is under the age of 18)

PLEASE CLICK THE NEXT BUTTON BELOW IF THIS SECTION DOES NOT APPLY TO YOU.

Signature:

Clear

Date:

THIRD PARTY/AUTHORISED AGENT SIGN

Authorised Agent
(person responsible for the applicant, such as a legal representative)

Print name:

Signature:

Clear

Date:

If this does not apply to you, please click the 'NEXT' button below 

THREE     DOCUMENTS ARE REQUIRED TO CONFIRM YOUR IDENTITY

+ PLUS A SELFIE PHOTO OF YOU HOLDING YOUR ID

 1    COMMENCEMENT OF IDENTITY  (to confirm your birth or arrival in Australia)

 2     PRIMARY USE IN THE COMMUNITY  (to show the use of your identity in the community)

 3    SECONDARY USE IN THE COMMUNITY DOCUMENT 

 +    SELFIE PHOTO OF YOU HOLDING YOUR ID

IDENTIFICATION UPLOAD

IMPORTANT INFORMATION!!

• The combination of your 3 documents must contain your full name, date of birth and a photo.  Please ensure your documents contain the same name and personal details that you provided earlier in this form.  All documents must be current.

• You will be asked if you are currently using a device with a camera to take a photo of yourself holding 1 of your photo IDs.  You must provide at least 1 selfie photo of yourself holding the photo ID to confirm the ID belongs to you.

• If none of your documents contain a photo, you must submit a certified passport-style photograph certified by an authorised declarations officer.

YOU WILL NEED ACCESS TO A  SCANNER OR A  MOBILE DEVICE WITH A CAMERA TO UPLOAD YOUR ID DOCUMENTS -PLEAE MAKE SURE THESE ARE NOT BLACK AND WHITE IMAGES

SELECT YOUR DOCUMENTS

1. Select START OF IDENTITY document: *Please Selectfull Australian Birth Certificatecurrent Australian PassportAustralian Visa (supported by a foreign passport) ImmiCardAustralian Citizenship CertificateI don't have these documents - Special Provisions

2. Select PRIMARY USE IN THE COMMUNITY document: *Please SelectAustralian Drivers Licence, learner permit, provisional licence issued by a state or territory with signature and/or photoA passport issued by a country other than Australia with a valid visa or valid entry stamp or equivalentcurrent Proof of Age/Photo Identity CardFor persons aged under 18 years with no other Primary Use in Community Documents, a student identity documentcurrent Australian PassportImmiCardI don't have any of these documents

3. Select SECONDARY USE IN THE COMMUNITY document: *Please selectofficial DFAT issued Travel/Identity documentcurrent Foreign government issued documents (for example, drivers licence)current Medicare Cardvalid Enrolment with the Australian Electoral Commission (AEC)current Security Guard or Crowd Control photo licenceCentrelink Health Care Card or Pensioner Concession Cardcurrent Consular photo identity card (issued by DFAT)current Photo identity card (issued to an officer by a police force)current Photo identity card (issued by the Australian Defence Force)current Photo identity card (issued by an Australian government eg Working with Children/Occupational Licence)current Aviation security identification cardcurrent Maritime security identification cardcurrent & valid Credit Reference Checkcurrent Australian tertiary or secondary student photo identity documentcertified academic transcript from an Australian universityverifiable Trusted referees reportBank statementrecent Australian Taxation Office assessment noticedocument of Identitycertificate of IdentityFirearms LicenceI don't have any of these documents Special Provisions Required

full AUSTRALIAN BIRTH CERTIFICATE (not an extract, birth card or commemorative certificate)

First name on your Birth Certificate: *

Middle Name(s) (as it appears on your birth certificate):

Surname on your Birth Certificate: *

Date of birth on your Birth Certificate: *

Registration state or territory: *SelectACTNSWNTQLDSATASVICWAOther

Birth Registration Number: *

Birth Registration Date: *

UPLOAD BIRTH CERTIFICATE: *

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UPLOAD BIRTH CERTIFICATE: (back of certificate)

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1. CURRENT AUSTRALIAN PASSPORT - not expired, (however, if the Document Verification Service (DVS) is used to verify the passport, it may be up to 2 years expired)

2. PRIMARY USE IN THE COMMUNITY DOCUMENTS - CURRENT AUSTRALIAN PASSPORT - (including Ordinary, Frequent traveller, Diplomatic, Official and Emergency (not expired; however, if the Document Verification System (DVS) is used to verify the passport, it may be up to 2 years expired);

Passport Number: *

First Name on your Passport: *

Middle Name(s) (required if you have one):

Surname on your Passport: *

Date of Birth on Passport: *

UPLOAD PASSPORT: *

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AUSTRALIAN VISA - (supported by a foreign passport, which is needed for verification) current at the time of entry into Australia as a resident or tourist. This can also be accessed through the Visa Entitlement Verification Online (VEVO) system delivered by the Department of Home Affairs; and

Full Name (as it appears on your Australian Visa): *

Date of Birth on your Australian VISA: *

Foreign Passport Number: *

Country of your passport *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

UPLOAD AUSTRALIAN VISA & accompanying FOREIGN PASSPORT - 1/1 *

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UPLOAD AUSTRALIAN VISA & accompanying FOREIGN PASSPORT - 1/2

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ImmiCard - by the Department of Home Affairs to assist visa holders to provide evidence of their Commencement of Identity in Australia; and

ImmiCard number: *

ImmiCard Type:Evidence of Immigration Status ImmiCardAustralian Migration Status ImmiCard

First Name on your ImmiCard: *

Middle Name(s)

Surname on your ImmiCard: *

Date of Birth on your ImmiCard: *

UPLOAD IMMICARD: *

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UPLOAD IMMICARD:(back of card) optional

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official DFAT issued Identity Document

Which DFAT document do you have? *

DFAT Certificate of IdentityDFAT Document of Identity

DFAT document number: *

Full Name (as it appears on your DFAT document): *

UPLOAD DFAT CERTIFICATE / DOCUMENT OF IDENTITY: (front of document)) *

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UPLOAD DFAT CERTIFICATE / DOCUMENT OF IDENTITY (back of document) optional

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Certificate of Evidence (of resident status)

Full Name (as it appears on your Certificate of Evidence of Resident Status): *

Country Certificate Issued: *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

Certificate of Evidence of Resident Status number: *

UPLOAD FRONT OF CERTIFICATE OF EVIDENCE (OF RESIDENT STATUS): 1/1 *

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UPLOAD BACK OF CERTIFICATE OF EVIDENCE (OF RESIDENT STATUS) - 1/2

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UPLOAD FRONT OF CERTIFICATE OF EVIDENCE (OF RESIDENT STATUS): 1/3

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UPLOAD FRONT OF CERTIFICATE OF EVIDENCE (OF RESIDENT STATUS): 1/4

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Australian Citizenship Certificate

Given Name(s) on your Australian Citizenship Certificate: *

Family Name on your Australian Citizenship Certificate: *

Certification/Issued date (DD/MM/YYYY) *

Australian Citizenship Certificate stock number: *

UPLOAD AUSTRALIAN CITIZENSHIP CERTIFICATE: (front page) *

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UPLOAD AUSTRALIAN CITIZENSHIP CERTIFICATE (back page) *

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Special Provisions

 Verification of Applicant Identity by an Authorised Referee Form

This form is for applicants who have not met the minimum identity proofing requirements outlined in the nationally coordinated criminal history check – Application and informed consent form. In order to meet the requirements for a nationally coordinated criminal history check, an authorised referee must provide a reference to confirm your identity. The definition of authorised referee is outlined in Section 3.

DOWNLOAD FORM

Please upload your completed Identity Assurance Form - (Page 1) *

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Please upload your completed Identity Assurance Form - (Page 2)

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1. Other Supporting Documents - (Optional)

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2. Other Supporting Documents (optional)

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current Australian Drivers Licence - learner permit or provisional licence issued by a state or territory, showing a signature and/or photo

First Name on your Drivers Licence: *

Middle Name(s)

Surname on your Drivers Licence: *

Drivers Licence issued in State/Territory: *SelectACTNSWNTQLDSATASVICWAOther

Drivers Licence Number: *

Driver Licence Card Number: *

UPLOAD FRONT OF DRIVERS LICENCE: *

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UPLOAD BACK OF DRIVERS LICENCE *

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Non-Australian Passport (current) issued by a country other than Australia with a valid entry stamp or visa

Non-Australian Passport number: *

Given Name(s) on your Non-Australian Passport: *

Family Name on your Non-Australian Passport: *

Country of Passport: *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

Date of Birth on your Non-Australian Passport: *

UPLOAD CURRENT NON-AUSTRALIAN PASSPORT: *

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UPLOAD CURRENT NON-AUSTRALIAN PASSPORT - 1/2

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Current Proof of Age or Photo Identity Card (current) issued by an Australian Government agency in the name of the applicant, with a photo

Full Name (as it appears on your Proof of Age / Photo Identity Card): *

Card / Reference / CRN Number of your Proof of Age / Photo Identity Card:

Date of Birth on your Proof of Age / Photo Identity Card:

Expiry Date of your Proof of Age / Photo Identity Card: *

UPLOAD FRONT OF PROOF OF AGE / PHOTO IDENTITY CARD *

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UPLOAD BACK OF PROOF OF AGE / PHOTO IDENTITY CARD

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current Shooters / Firearms Licence

Firearms Licence No: *

Firearms Licence Date of Expiry: *

Full Name (as it appears on your Firearms Licence): *

Date of Birth on your Firearm Licence: *

State Issued:ACTNSWNTQLDSATASVICWA

UPLOAD FIREARMS LICENCE: (Front of Card) *

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Upload Firearms Licence (Back of Card) *

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For persons aged under 18 years with no other Primary Use in Community Documents, a student identity document

FULL Name (as it appears on your Student Identification document): *

Date of Birth on your Student Identification document:

Student Identification document No:

Student Identification Date of Expiry:

UPLOAD STUDENT IDENTIFICATION DOCUMENT: *

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UPLOAD STUDENT IDENTIFICATION DOCUMENT (back)

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official DFAT issued Travel / Identity document

Which DFAT issued document do you have? *

Australian Certificate of Identity (issued by DFAT)Australian Document of Identity (issued by DFAT)Convention travel document secondary (United Nations) issued by DFAT

First Name on your DFAT document: *

Middle Name(s) required if you have one:

Surname on your DFAT document: *

Date of Birth on your DFAT document: *

DFAT document number: *

Country Document Issued: *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

UPLOAD DFAT ISSUED DOCUMENT: (front) *

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UPLOAD DFAT ISSUED DOCUMENT: (back) - optional

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current Foreign Government issued documents (eg: drivers licence)

Full name on your Foreign Government issued document: *

Date of Birth on your Foreign Government issued document: *

Foreign Goverment issued document number: *

Expiry Date: *

Country Issued: *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

UPLOAD FOREIGN GOVERNMENT ISSUED DOCUMENT: *

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UPLOAD FOREIGN GOVERNMENT ISSUED DOCUMENT: (back)

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current Medicare Card

Full Name (as it appears on your Medicare Card): *

Medicare Card number: *

Individual Reference No: *

Medicare Card Expiry Date: (MM/YYYY) or (DD/MM/YYYY) *

Date of Birth *

UPLOAD MEDICARE CARD: *

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valid Enrolment with the Australian Electoral Commission (AEC)

FULL Name on your AEC enrolment: *

AEC Enrolment No:

AUSTRALIAN ELECTORAL ENROLMENT DETAILS UPLOAD: *

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current Security Guard or Crowd Control photo licence

Full Name (as it appears on your Security Licence): *

Security Providers Licence No: *

Security Licence Card Expiry Date: *

SECURITY GUARD OR CROWD CONTROL PHOTO LICENCE UPLOAD: (front of card) *

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SECURITY GUARD OR CROWD CONTROL PHOTO LICENCE UPLOAD: (back of card) *

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Centrelink Health Care Card or Pensioner Concession Card

Full Name (as it appears on your Australian Government Benefit document): *

Centrelink Card Type *Health Care CardSeniors Health CardPensioner Concession Card

Date of Birth *

CRN / Number: *

Card Expiry Date *

EVIDENCE OF RIGHT TO AN AUSTRALIAN GOVERNMENT BENEFIT UPLOAD: (Front of card) *

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EVIDENCE OF RIGHT TO AUSTRALIAN GOVERNMENT BENEFIT UPLOAD - (back of card) *

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current Consular photo identity card (issued by DFAT)

Full name (as it appears on your Consular Photo Identity Card): *

Select Country Consular Photo Identity Card was Issued: *AfghanistanAlbaniaAlgeriaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanThe BahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCentral African RepublicChadChileChinaColombiaComorosCongo, Republic of theCongo, Democratic Republic of theCosta RicaCote d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast Timor (Timor-Leste)EcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFijiFinlandFranceGabonThe GambiaGeorgiaGermanyGhanaGreeceGrenadaGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, NorthKorea, SouthKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesia, Federated States ofMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmar (Burma)NamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorwayOmanPakistanPalauPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth SudanSpainSri LankaSudanSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited States of AmericaUruguayUzbekistanVanuatuVatican City (Holy See)VenezuelaVietnamYemenZambiaZimbabwe

Date of Expiry of Consular Photo Identity Card: *

CONSULAR PHOTO IDENTITY CARD UPLOAD: (front of card) *

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CONSULAR PHOTO IDENTITY CARD UPLOAD:(back of card)

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current Photo Identity Card (issued to an officer by a police force)

Full Name (as it appears on your Police Photo Identity Card:) *

Card Number (as it appears on your Police Photo Identity Card:) *

Date of Expiry (as it appears on your Police Photo Identity Card:) *

POLICE PHOTO IDENTITY CARD UPLOAD 1/1 (Front): *

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POLICE PHOTO IDENTITY CARD UPLOAD 1/2 (Back):

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current Photo identity card (issued by the Australian Defence Force)

Full Name (as it appears on your ADF Photo Identity Card): *

Card Number (as it appears on your ADF Photo Identity Card): *

Date of Expiry (as it appears on your ADF Photo Identity Card): *

ADF PHOTO IDENTITY CARD UPLOAD: (front of card) *

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ADF PHOTO IDENTITY CARD UPLOAD: (back of card)

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current Photo identity card (issued by an Australian government eg Working with Children/Occupational Licence)

Full Name on your Australian Government ID: *

Card No: *

Sate Card Issued *ACTNSWNTQLDSATASVICWA

Expiry Date: *

AUSTRALIAN GOVERNMENT PHOTO IDENTITY CARD UPLOAD: (front of card) *

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AUSTRALIAN GOVERNMENT PHOTO IDENTITY CARD UPLOAD: (back of card) *

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current Aviation Security Identification Card

Full Name on your Aviation Security ID: *

Card Number on your Aviation Security ID: *

Date of Expiry on your Aviation Security ID: *

AVIATION SECURITY IDENTIFICATION CARD UPLOAD: (front of card) *

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AVIATION SECURITY IDENTIFICATION CARD UPLOAD: (back of card) - optional)

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current Maritime Security Identification Card

Full Name on your Maritime Security ID: *

Card Number (as it appears on your Maritime Security ID): *

Date of Expiry on your Maritime Security ID: *

MARITIME SECURITY IDENTIFICATION CARD UPLOAD: (front of card) *

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MARITIME SECURITY IDENTIFICATION CARD UPLOAD: (back of card) - optional

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current and valid Credit Reference Check

Full Name on your Credit Reference Check: *

CREDIT REFERENCE CHECK UPLOAD: 1/1 *

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CREDIT REFERENCE CHECK UPLOAD: 1/2

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current Australian Tertiary or Secondary Student Photo Identity document

Full Name (as it appears on your Student Photo Identity document): *

Document / Card Number (as it appears on your Student Photo Identity document): *

Date of Expiry (as it appears on your Student Photo Identity document): *

AUSTRALIAN STUDENT IDENTITY DOCUMENT UPLOAD:(front of document) *

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AUSTRALIAN STUDENT IDENTITY DOCUMENT UPLOAD: (back of card)

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certified Academic Transcript from an Australian university

Full Name on your Academic Transcript: *

CERTIFIED ACADEMIC TRANSCRIPT UPLOAD: 1/1 *

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CERTIFIED ACADEMIC TRANSCRIPT UPLOAD: 1/2 - optional

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verifiable Trusted Referees Report

Full Name on your Trusted Referees Report: *

TRUSTED REFEREES REPORT UPLOAD: 1/1 *

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TRUSTED REFEREES REPORT UPLOAD: 1/2

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Bank Statement

FRONT OF YOUR BANK DOCUMENT: *

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recent Australian Taxation Office Assessment Notice

Full Name on your ATO Assessment Notice: *

Tax File No: *

AUSTRALIAN TAXATION OFFICE ASSESSMENT NOTICE UPLOAD: 1/1 *

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AUSTRALIAN TAXATION OFFICE ASSESSMENT NOTICE UPLOAD: 1/2

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Change of name

If you (applicant) provide identity documents using a former name or maiden name, you must provide one of the below documents as evidence of the name change, in addition to your four identify documents

If this does not apply to you click the 'NEXT' button below and go to the next question

Change of name certificate issued by the Australian Registry of Births, Deaths and Marriages;

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Australian marriage certificate issued by a state or territory (church or celebrant certificates are not accepted);

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Deed Poll this document can no longer be applied for but any persons already holding this document can use it;

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A relationship certificate issued by a state or territory Births, Deaths and Marriages.

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UPLOAD SELF PHOTO

'SELFIE' UPLOAD INSTRUCTIONS

Please take a photo of yourself HOLDING one of the ID's that you have UPLOADED

MAKE SURE YOUR PHOTO IS A CLEAR IMAGE AND YOUR ID CAN BE EASILY READ

Click below to take a photo or upload an image

UPLOAD PHOTO *

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Jobseeker/Applicant - Please VERIFY your EMAIL address...

Enter your email address: *

Re-enter & verify your email address *

Send code

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ORDER DETAILS

Nationally Coordinated Criminal History Check	$50.00
Total (inc GST)	$50.00

Volunteer Police Check	$23.00
Total (inc GST)	$23.00

Please enter your Credit Card details: *

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