Working With Children Check Employment Screening Consent Form
WORKING WITH CHILDREN CHECK
EMPLOYMENT SCREENING CONSENT FORM
This form is to be completed by persons whose names are to be submitted for
employment screening as part of the Working W ith Children Check.
No background checks can be completed on a person without this consent being provided.
Employers are required to sight applicant’s original identifying documents.
All fields must be completed in block letters
Surname: Given name(s):
Previous names/aliases: Date of birth:
Place of birth (city, state, country):
Driver’s licence number: Gender: (Please tick) Male Female
Suburb: State: Postcode:
Contact telephone number:
Type of position: (Please tick) Paid employee Volunteer Student placement
Title of position applied for:
I certify that the above information is accurate and understand that if I have provided false or misleading information it may result in a
decision not to employ me, or, if already employed, may lead to my dismissal.
I am aware that if considered for employment in a child-related position, several checks will be undertaken to ascertain my suitability,
1. a national criminal record check for charges and/or convictions (including spent convictions) for:
•any sexual offence (including but not limited to, sexual assault, acts of indecency, child pornography, child prostitution and carnal knowledge);
•any assault, ill treatment or neglect of, or psychological harm to a child;
•any registrable offence;
carrying a minimum penalty of 12 months or more imprisonment.
I understand that this check includes convictions or charges that:
•may have not been heard or finalised by a court;
•are proven but have not led to a conviction; or
•have been dismissed, withdrawn, quashed or discharged by a court.
2. a check for relevant Apprehended Violence Orders taken out by a police officer or other public official for the protection of a child/ren;
3. a check for relevant employment proceedings involving reportable conduct or an act of violence committed by the employee in the
course of employment and in the presence of children. Reportable conduct means any sexual offence, or sexual misconduct
committed against, with or in the presence of a child (including a child pornography offence), or any assault, ill treatment or neglect of
a child, or any behaviour that causes psychological harm to a child.
I understand that a conviction for a serious sex offence (including, but not limited to, sexual assault, acts of indecency, child
pornography, child prostitution and carnal knowledge) will automatically prohibit my employment in a child-related position. This
includes a charge that is proven in court but does not proceed to a conviction. I am aware that if I am a “registrable person” under the
Child Protection (Registrable Offenders) Act, 2000, I am prohibited from employment in a child-related position.
I consent to these checks being conducted and am aware that if any relevant record is identified, additional information relating to that
record may be sought by an Approved Screening Agency from sources such as courts, police, prosecutors and past employers to
enable a full and informed assessment.
I acknowledge that:
(i) any information obtained as part of this process may be used by Australian Police Services for law enforcement purposes, including
the investigation of any outstanding criminal offences;
(ii) the outcome of assessment of information obtained through the Working with Children Check by the approved screening agency
may be provided to my current or prospective employers only for background checking purposes; and
(iii) the information provided may be referred to the Commission for Children and Young People and/or to NSW Police for law
enforcement purposes and for monitoring and auditing compliance with the procedures and standards for employment screening in
accordance with Section 36 (1) (f) of the Commission for Children and Young People Act 1998.
(iv) the above information and any information obtained during employment screening may be collected and used by and/or disclosed
to the Commission for Children and Young People or any Approved Screening Agency for employment screening purposes.
NOTE: This form is to be retained by the employer.
NSW Commission for Children and Young People
Working With Children Check Employment Screening Consent Form PDF
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