Form P608 – Fill Out and Use This PDF

P608

Application by an INDIVIDUAL FOR A NSW

SECURITY LICENCE under the Mutual Recognition Act 1992 and/or Trans-Tasman Mutual Recognition Act 1997

OFFICE USE ONLY

Application No:

-

Trim No:

To apply for a NSW security licence under mutual recognition principles, you M UST satisfy the follow ing requirements:

1.You M UST hold a current equivalent interstate licence;

2.You M UST hold either a NSW Driver Licence OR a Photo Card OR an RMS Customer Number issued by Roads & Maritime Services (RMS) showing your current name; AND

DO NOT PROCEED W ITH THIS APPLICATION UNLESS YOU M EET ALL OF THESE REQUIREM ENTS.

Please use a BLACK or BLUE PEN. Print clearly within the boxes in CAPITAL LETTERS.

1PERSONAL DETAILS

1.1Provide your full last name and any given name(s).

LAST NAME		GIVEN NAME(S)

1.2Have you ever been known by any other name(s) (eg: maiden name)?

NO

YES

(Provide details below, including when you stopped using the name)

LAST NAME

GIVEN NAME(S)

DATE CEASED

/

/

LAST NAME

GIVEN NAME(S)

DATE CEASED

/

/

1.3Provide your current residential address (NOT a PO Box) and your postal address (if different from your residential address).

RESIDENTIAL ADDRESS

SUBURB/TOWN		STATE	POSTCODE

POSTAL ADDRESS (IF SAME AS RESIDENTIAL ADDRESS, WRITE ‘AS ABOVE’)

SUBURB/TOWN		STATE	POSTCODE

1.4Provide your date of birth in the format dd/mm/yyyy. You must also provide your:

Country of birth

Telephone number during business hours & mobile number

Gender (M = Male; F = Female)

Email address (if applicable)

DATE OF BIRTH

COUNTRY OF BIRTH

GENDER (M or F)

/

/

If you were born in Australia, provide the State/Territory and Suburb/Town.

STATE/TERRITORY

SUBURB/TOWN

TELEPHONE NO (BUSINESS HOURS)

MOBILE OR OTHER

EMAIL ADDRESS (IF APPLICABLE)

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2STATEM ENTS REQUIRED UNDER THE MUTUAL RECOGNITION ACT 1992

2.1Section 19(2) of the Mutual Recognition Act 1992 requires you to make certain statements regarding your seeking registration for the equivalent occupation in accordance with mutual recognition principles. You must tick either True or False to each and every statement below. There are severe penalties for making statements that are untrue and/or misleading.

I make the following statements:

I hold an equivalent class of licence in another State.

2.2Tick the licence for which you are seeking registration. Registration for a Master Licence only available to individuals NOT corporations. I seek registration for the following licence in accordance with the mutual recognition principle:

CLASS 1 LICENCE

CLASS 2 LICENCE

M ASTER LICENCE

2.3I am not the subject of disciplinary proceedings in any State (including any preliminary investigations or action that might lead to disciplinary proceedings) in relation to equivalent licences held. (See Section 6 - Notes)

TRUE FALSE

2.4No licences I hold or have previously held in any State have been cancelled or are currently suspended as a result of disciplinary action. (See Section 6 - Notes)

TRUE FALSE

2.5I am not otherwise personally prohibited from working in the security industry in any State or Territory, nor am I the subject of any special conditions in carrying on that occupation, as a result of criminal, civil or disciplinary proceedings in any State. (See Section 6 - Notes)

TRUE FALSE

2.6If you have answered “False” to any of the above statements, provide details below.

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3FURTHER INFORM ATION

3.1Specify all States in which you hold an equivalent licence. (See Section 6 - Notes) I current hold the following equivalent licence(s)

LICENCE NUMBER	LICENCE CLASS(ES)	STATE	APPLICATION DATE	EXPIRY DATE

You M UST provide an original certified copy of both the FRONT and BACK of your interstate or New Zealand security licence. If you have a New Zealand security licence, you MUST supply an original certified copy of your Certificate of Approval.

3.2Specify any special conditions which apply to your working in the security industry in any State.

4APPLICATION FEE

4.1Indicate the term of licence required.

Class 1 and/or Class 2 Licence
1 YEAR		$160.00					5 YEARS		$640.00
Master Licence (only available to individuals Not corporations)
1	YEAR			MA $160.00					MB	$410.00				MC	$1,250.00		MD	$2,800.00		ME	$5,225.00
5	YEARS
				MA $640.00					MB	$1,640.00				MC	$5,000.00		MD	$11,200.00		ME	$20,900.00

If applying to have your Master Licence mutually recognised, please provide your Australian Business Number (ABN) Note: the ABN must be in the applicant’s name.

4.2Insert fee payable.

FEE PAYABLE $

4.3Indicate payment method. Cheques and Money Orders are to be made payable to NSW Police Force.

DO NOT SEND CASH.

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5STATUTORY DECLARATION AND CONSENT

5.1A statutory declaration under the Statutory Declarations Act 1959 may be made before authorised persons, including:

	A currently licensed or registered:				A person in the follow ing list:
	•	Chiropractor	•	Optometrist	•	Bank, building society or credit	•	Person before whom a statutory
	•	Dentist	•	Pharmacist		union officer with five or more		declaration may be made under
						continuous years of service		the law of the State or Territory in
	•	Legal Practitioner	•	Physiotherapist
					• Justice of the Peace			which the declaration is made
	•	Medical Practitioner	•	Psychologist
					•	Notary Public	•	Police Officer
	•	Nurse	•	Veterinary Surgeon
					• Registrar or Deputy Registrar or		•	Sheriff
						Clerk of a Court

I, (Print full name)

of (Print current address)

Make the following declaration under the Statutory Declarations Act 1959:

1.The statements and other information provided in this application are true and correct;

2.All copies of documents provided with this application are complete and accurate copies of the originals; and

3.I consent to the making of inquiries of, and exchange of information with, the authorities of any Australian State or Territory or New Zealand regarding my activities in the relevant occupations or otherwise regarding matters relevant to this notice.

I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959 and I believe that the statements in this declaration are true in every particular.

Signature of Applicant:

Declared at

PRINT THE PLACE WHERE DECLARATION WAS MADE

on

PRINT THE DATE THAT THE STATUTORY DECLARATION WAS MADE

Before me:

NAME AND SIGNATURE OF THE PERSON BEFORE WHOM THE DECLARATION IS MADE

QUALIFICATION OF PERSON BEFORE WHOM THE DECLARATION IS MADE

ADDRESS OF PERSON BEFORE WHOM THE DECLARATION IS MADE

6NOTES

6.1You need to read and acknowledge the following notes which provide further information about the statements and information you have provided in Sections 2 and 3 of this application form.

Any reference to a “State” in Section 2 or 3 includes a Territory and any State in Australia (including New South Wales) and New Zealand.

6.2Revoked licences - training upgrade

A NSW security licence that was revoked because the licence holder failed to comply with the requirement to complete a required training upgrade is a licence that was “cancelled or suspended as a result of disciplinary action” (See Section 2.4).

If you have had a NSW licence revoked for failing to complete the training upgrade, you are not eligible to be granted a security licence in NSW under mutual recognition principles. Any application received from a person who has had a licence revoked on these grounds will be rejected.

	I acknowledge that I have read and understand the above notes.
6.3	SIGNATURE		DATE (dd/mm/yyyy)
					/			/

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7 APPLICATION CHECKLIST

Please tick that you have:

Provided an original certified copy of both the FRONT and BACK of your interstate or New Zealand security licence – EACH PAGE that has been photocopied must be signed by a Justice of the Peace, Legal Practitioner or Public Notary as a true and correct copy of the original;

Provided, if relevant, an original certified copy of both the FRONT and BACK of your New Zealand Certificate of Approval – EACH PAGE that has been photocopied must be signed by a Justice of the Peace, Legal Practitioner or Public Notary as a true and correct copy of the original;

Provided identical names on the form and documents; or

Provided, if applicable, an acceptable change of name document(s);

(Acceptable change of name documents must show a clear link between all your names and are limited to the following:

•Marriage certificate(s) issued by the NSW Registry of Births, Deaths & Marriages or, if you were married elsewhere, a certified copy of the marriage certificate issued by the celebrant or church

•Change of Name certificate issued by the NSW Registry of Births, Deaths & Marriages

•Full birth certificate showing your name at birth and your new name (Extracts and Commemorative certificates are NOT acceptable)

•Divorce decree

•Deed poll registered with the relevant authority

•Instrument evidencing change of name registered in the Land Titles Office)

Chosen the correct equivalent licence class(es), subclass(es) and term of licence required;

Completed all required sections;

Signed the Statutory Declaration and Consent before an authorised person; and

Provided the correct payment.

Forw ard the completed application form to:

Security Licensing & Enforcement Directorate

NSW Police Force

Locked Bag 5099

PARRAMATTA NSW 2124

IM PORTANT:

YOUR APPLICATION W ILL BE DELAYED IF IT IS NOT FULLY COM PLETED AND/ OR YOU HAVE NOT PROVIDED THE REQUIRED DOCUM ENTATION AND FEE PAYM ENT.

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