Informed Consent Form Dcsi Screening Unit Child-Related Employment Screening Page 4

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Part C: 100 Point Identification Check
The verifying officer must sight original documents. The Screening Unit does not require photocopies.
Category A (70 points) only one of these documents can be accepted
Points
Birth certificate
Number:
Citizenship certificate
International travel document
Country of Issue:
This may be a current passport, or an expired
passport which has not been cancelled and was
Expiration Date:
current within the preceding 2 years.
Category B (the first document ONLY 40 points, subsequent documents 25 points)
Points
Australian driver’s licence
Number:
Australian licence or permit (please specify)
Department of Veterans’ Affairs (DVA) card
State of Issue:
Centrelink card
Government employee identification card
Issuer:
Tertiary student identification card
Expiration Date:
Secondary student identification card
Category C (25 points, tick twice if more than one credit card or utilities notice has been sighted)
Points
Medicare card
Seniors card
Proof of age card
International Driver’s Licence
Credit card, savings account card (if more than one card, they must be from different institutions)
Utilities notice (eg water rates, electricity, gas or telephone account)
TOTAL POINTS
Verification of Identity
I am a responsible manager within the requesting organisation, a Justice of the Peace, or Commissioner for
taking affidavits (solicitor, barrister, or proclaimed police officer).
I have viewed the original documentation provided by the applicant which complies with the 100 point check
requirements under the Financial Transactions Reports Act 1988 (Cth).
I confirm that the information provided by the applicant in this form is accurate, legible and corresponds with the
original identification documents provided.
I have sighted the original identification provided by the applicant and verify that the person referred to in these
documents is the applicant who has signed page 3 of this Informed Consent Form.
I have viewed change of name documentation provided by the applicant (where applicable).
Name of applicant:
Name of verifying officer:
ID Number:
Position:
Organisation:
Business Address:
Suburb/town:
State:
Postcode:
Telephone:
(W)
(M)
Email address:
Signature of verifying officer:
Date:
C4 | DCSI Screening Unit  screening@dcsi.sa.gov.au   1300 321 592

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