Working with Children Check Notification of Change of Personal Details Form
Working with Children Check
Notification of Change of
Personal Details Form
Update my address Complete Section 1,2 and 5
Update my contact phone numbers Complete Section 1,3 and 5
Update my employer or organisation details Complete Section 1,4 and 5
Section 1 Your Details
Title (eg. Mr, Ms, Mrs, Miss, Dr)
Family Name (Surname)
Gender:
Male
Female
X
First Name and Middle Name/s
Date of Birth:
D
D
M M Y Y Y Y
X
Current Card/Application Receipt Number
X
X
X
Section 2 Current Address
To advise of your change of personal details please complete this notification form and post it to:
Working with Children Check Unit
GPO Box 1915
MELBOURNE VIC 3001
The information you provide on this form will be used to update your record.
If you have changed your name or need a replacement card please use the Replacement Card Application Form which is
available for printing from the Working with Children (WWC) Check web site at www.justice.vic.gov.au/workingwithchildren)
or by contacting the WWC Check Information Line on 1300 652 879.
Privacy Statement
The Department of Justice is bound by Victorian privacy laws (Information Privacy Act 2000 and Health Records Act
2001). The personal information you provide will be used to update your record and to monitor your continuing suitability
to work with children. This information may also be disclosed to other agencies, including police services in Australia and
the Victorian Institute of Teaching, as provided for in the Working with Children Act 2005. If you do not provide all relevant
personal details, we may not be able to process your request. For further information about accessing your personal
information or our full privacy statement please refer to the website at www.justice.vic.gov.au/workingwithchildren or
contact the Information Line on 1300 652 879.
Please print in black pen within the boxes in block letters.
WWCCU Change Personal Details Form July 06 Page 1 of 2
Section 3 Current Contact Phone Numbers
Mobile Contact Number
Home Contact Phone Number
Work Contact Phone Number
Reason for Notification
I would like to (cross all that apply)
Residential Address
Suburb/Locality
State Postcode
Postal Address (if different to above)
Suburb/Locality
State Postcode
Page 1/2
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