Form Cr500 – Fill Out and Use This PDF

the Application completion Guide (e.g. Fire fighting/prevention = Code No 15)

If a code is not specified this application will be processed as a Standard Disclosure (Code 30).

If the purpose is not listed or you are unsure please ring the AFP Criminal Records Help Desk on 02 6202 3333 for assistance.

2. Applicant Details

If completing manually use form CR500m. Mark check boxes with a cross (X).

Previous or Other Names by which you are known or have been formerly known must be listed below (eg. maiden, deed poll). If more room is required, list on separate sheet, sign and send with this application form. Additional information sheet included

4. Mailing Address for Police Certificate

The National Police Certificate will be posted to the account holder listed at Section 3 of this application.

5.Fingerprints Please note that a fingerprint check is only required under very limited circumstances. Please ensure that you are actually required to have a fingerprint check conducted before going to the expense of this level of check by checking with the organisation/department requesting the check.

one of the below statements. For information on fingerprint checks see Section 5: Fingerprint Checks on the Application Completion Guide.

6.Consent

i.I acknowledge I have read the Application Completion Guide for this application form (pages 3 – 6) and I am aware exclusions from spent convictions legislation may apply to some categories of NPCs.

ii.The personal information I have provided on this form (including fingerprints if supplied) relates to me and is correct.

iii.I acknowledge the details contained on this form, including fingerprints where relevant, will be forwarded to the AFP, CrimTrac, and/or the Police Services of the States or Territories of the Commonwealth of Australia.

iv.I consent to the AFP and any other Australian police force extracting details of any convictions, findings of guilt or pending court proceedings relating to me, including in relation to any traffic offence, and providing that information to me or to the Employer/Organisation named in Section 3 above, as approved or to another person agency as named in Section 4.

v.I acknowledge the information provided on this form will not be used without my prior consent for any other purpose, unless otherwise authorised by law.

vi.I acknowledge that any information provided on this form or disclosed by the police as a result of the records check may be taken into account by the organisation mentioned in (3) above or any organisation to whom I present the results of the records check in assessing my suitability to receive the entitlement.

Spent Convictions Legislation

The aim of spent convictions legislation is to prevent discrimination on the basis of certain previous convictions. Spent convictions legislation limits the use and disclosure of older, less serious convictions and findings of guilt.

There are some offences excluded from being spent where the check is required for certain purposes as indicated in the table above – these offences will be released regardless of how old they are.

Where a record exists within an Australian police jurisdiction, relevant spent conviction legislation/policies governing the release of that information for that jurisdiction will be applied. As a result certain convictions will not be released provided this is in accordance with the relevant legislation/policies.

For Commonwealth records the AFP applies the provisions within Part VIIC of the Crimes Act 1914 and for ACT records provisions within the ACT Spent Convictions Act 2000 are applicable. If further information or clarification is required please contact the individual jurisdiction where the record is held.

Provision of False or Misleading Information

You are asked to certify that the personal information you have provided on this form is correct. Where your check is for employment related purposes and the result is to be provided to your employer or other organisation, discovery of any false or misleading information may be reported by the AFP and may impact on the decision being undertaken by the employer or organisation.

The AFP provides information, with your consent, to the employer or organisation but takes no part in any subsequent assessment.

Disputed Record Enquiries

If you believe the information provided on your police certificate is incorrect or inaccurate a Disputed Record form (CR 1200) is available from the AFP website. This form should be forwarded to the AFP through the agency or organisation with whom you have lodged your application for a National Police Check.

Include any additional information or documents supporting your enquiry to enable the AFP to more accurately assess your application. In some instances the AFP may require comparison fingerprints to resolve some disputes. Applicants will be notified in such instances.

The Privacy Commissioner is responsible for ensuring the protection of private information relating to individuals. This includes investigating instances where information has been released improperly or incorrectly. An individual who believes the standards dealing with disclosure and use of old conviction information have been breached may apply to the Privacy Commissioner for an investigation of the matter. The phone number is 1300 363 992.

The following requirements must be met when submitting an AFP National Police Check (NPC).

Account Customer - Completion Check List

Failure to meet the required standards will result in the form being returned for amendment.

OEnsure Section 1 Purpose of NPC has been completed

OA copy of an Australian driver’s licence or other acceptable identification (eg

passport, certified full birth certificate, certified marriage certificate) must accompany the application unless you have been otherwise advised. Do not send original documents.

OEnsure all the necessary details have been completed and the form is signed and dated.

OIf completing by hand use BLOCK LETTERS and black ink.

OMark the appropriate check boxes with a cross (X).

OAll previous or other names by which you are known or have been formerly known, including maiden name, must be listed in full on the form or on an enclosed additional sheet.

OAny attachments with additional information must be signed by the applicant.

OThe form must be submitted no more than three months after being signed by the applicant.

OIf the applicant is under 18 years of age the form must be signed by a parent/guardian.

ODo not send the Application Completion Guide (pages 3 – 6 of this form) to the AFP. Please retain these for your reference.