Working with Children Check Notification of Change of Personal Details Form
Section 5 Declaration
If updating your employer details above, please advise below all of the types of child related work in which
you currently work or volunteer or intend to work or volunteer and your status ie. volunteer or employee
(self-employed) (the Table of Child-Related Work Areas is available at the Working with Children Check Website
www.justice.vic.gov.au/workingwithchildren)
.
Section 4 Current Employer/Volunteer Organisation Details
Please list all organisations with whom you are currently undertaking child-related work. This will update your record
and any previous organisations you have listed will be deleted.
OFFICE USE ONLY
Date received
Incomplete - date returned
D
D
M M Y Y Y Y
D
D
M M Y Y Y Y
Date entered
D
D
M M Y Y Y Y
Entered by
WWCCU Change Personal Details Form July 06 Page 2 of 2
It is a criminal offence under section 39 of the Working with Children Act 2005 to provide false or misleading
information in relation to an application for a Working with Children Check.
I declare that the information I have provided on this form is true and correct.
Code Number Volunteer Employee
X X
X X
Code Number Volunteer Employee
X X
X X
Date
D
D
M M Y Y Y Y
➧
Your
signature
Street Address
Suburb/Locality
Employer/Volunteer Organisation HR Manager Contact Phone Number
Name of Other Organisation
State Postcode
Street Address
Suburb/Locality
Employer/Volunteer Organisation HR Manager Contact Phone Number
Name of Other Organisation
State Postcode
Street Address
Suburb/Locality
Employer/Volunteer Organisation HR Manager Contact Phone Number
Name of Other Organisation
State Postcode
Page 2/2
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