Fillable Informed Consent Form National Police Checking Service (Page 4 of 5) in pdf

INFORMED CONSENT FORM

NATIONAL POLICE CHECKING SERVICE

SECTION 6: PURPOSE OF THE NATIONAL POLICE HISTORY CHECK

Provide details of the purpose for which the check is required. Such as relevant position/role, place of work and whether you have contact

with vulnerable groups e.g. Client Services Officer in a call centre, janitor at a school, volunteer in aged care facility with direct care of

disabled and aged persons.

Employment with NSW Department of Education

Purpose or Role

SECTION 7: GENERAL INFORMATION

General information

The following links may be helpful in sourcing information on spent

convictions in your State/Territory:

Australian Criminal Intelligence Commission (ACIC) is collecting

Commonwealth

your personal information in this form in order to conduct a

National Police History Check (NPHC) on you. It does this through a

New South Wales

contractual arrangement with the Accredited Organisation named

Queensland

at Section 3. ACIC has contractual arrangements with its Accredited

South Australia

Organisations to collect personal information on its behalf to

Victoria Police

support processes assessing the suitability of people applying for

employment, Australian citizenship, appointment to positions

Western Australia

of trust, volunteer service or for various licensing or registration

Northern Territory

schemes. Accredited Organisations and their customers (such as

Australian

employers) use the personal information collected on this form

Capital Territory

and the resulting NPHC as part of their assessment process to

Tasmania

determine your application. Some Accredited Organisations have

a legislative basis for the collection, use and disclosure of your

Limitations on accuracy and use of PHI

personal information.

While every care has been taken by ACIC and police agencies

ACIC recommends that you seek further information about any

to conduct a search of PHI that relates to the Applicant, the

relevant/applicable legislative framework from the Accredited

accuracy and quality of an NPHC issued by ACIC depends on

Organisation.

accurate identification of the Applicant (including aliases),

In some circumstances Accredited Organisations may have

the comprehensiveness of police records and is based on the

information provided in this form. If the Applicant does not

arrangements with overseas entities for administrative or other

purposes. ACIC recommends that you seek further information from

complete the information requirements in this form the success and

validity of the NPHC will be compromised. It is in your interest to

the Accredited Organisation at Section 3 in circumstances where

provide full and complete details in this form.

your information is likely to be disclosed to overseas recipients.

Unless statutory obligations require otherwise, the information

If for any reason you do not agree with the results of your NPHC,

please notify the Accredited Organisation that submitted the

provided on this form will not be used without your prior consent

request for a NPHC on you so that the NPCS dispute process can be

for any purpose other than in relation to the assessment of your

suitability; or to maintain the records of ACIC and police agencies;

initiated.

or for law enforcement purposes. You will be required to complete

ACIC contact details

another consent form for any future NPHCs.

For more information regarding the NPHC process or the handling

National Police History Check (NPHC)

of Personal Information and Police History Information, you can

Information on this form will be used by ACIC and police agencies

contact the ACIC’s National Police Checking Service on:

for checking action; it will also be used to update records held

Phone: 02 6268 7900

about you by ACIC and police agencies.

Email:

npcs@acic.gov.au

ACIC and police agencies will access their records to obtain and

Provision of incomplete, false or misleading information

disclose Police History Information (PHI) that relates to you to:

An Accredited Organisation and an Applicant must take reasonable

a) the Accredited Organisation named in Section 3 above; and

steps to ensure that the personal information collected or disclosed

b) where applicable the employer/Organisation named in

is accurate, complete and up to date.

Section 5 above.

You are asked to certify that the personal information you have

PHI may include outstanding charges, warrant information and

provided on this form is correct.

criminal convictions/findings/pleas of guilt recorded against you.

It is a serious offence to provide false or misleading information on

PHI is disclosed according to applicable laws of the relevant

this form.

jurisdiction and, in accordance with the relevant jurisdiction’s

information release policies. Applicable laws include but are not

limited to spent convictions legislation.

Version 3.0

Informed Consent Form National Police Checking Service Page 4

Related Articles

Related forms

Related Categories