Welcome to Kerikeri Primary School, please find enclosed … · 2020-02-03 · As part of getting...

Welcome to Kerikeri Primary School, please find enclosed important information to complete

your child’s enrolment.

Please find enclosed

• School Information Booklet

• Enrolment Zone Map:

Please check that you live within our enrolment zone.

• Enrolment Form:

Please complete and return with the required documentation listed

below.

• Ko Wai Au? form:

Please complete and return.

• Oral Health Enrolment/Consent Form:

Please complete and return.

• ICT agreement form:

Please complete, sign and return.

Enrolment Documentation Checklist:

Completed Enrolment form

Birth Certificate or Passport (original to be sighted by office)

Proof of Address (eg Tenancy agreement, Power Bill)

Immunisation record if any

Visa (if required)

ICT Agreement

Police Vetting form (optional)

Documents:

Birth Certificate

Immunisation

DHB Form

Passport & Visas

Proof of Address

ICT Agreement

Pre-Enrol:Date Received: ...................Date due to start: ...............Year Level: ..........................Pre-enrol class: ..................Enrolment no: ....................Roopu: ...............................

Visits:1st .....................................2nd .....................................3rd .....................................4th .....................................Date started: ......................Bus: ....................................

Entered: by:

Etap ......................

ENROL ......................

EMER Folder

NSN no: ............................Room no: .........................Teacher: ...........................

OFFICE USE ONLY:

PARENT / CAREGIVER 1:

PUPIL DETAILS:

PARENT / CAREGIVER 2:

EMERGENCY CONTACT 1

EMERGENCY CONTACT 2

ADDITIONAL CHILDREN IN THE FAMILY

Pending Pre-Enrol Processed Completed

EnrolmentForm

(One form per pupil)Please bring all

documents listed.

Legal Surname: Preferred Surname:

Legal First Names: Preferred First Names:

Date of Birth: Gender: Male Female (please circle)

Citizenship: Ethnicity (up to three):

Iwi student belongs to - if applicable (up to three):

First language: Previous School attended:

First Names: Surname:

Relationship to Child: Phone:

Mobile: Email:

Residential Address (Pupil and Caregivers):Post Code:

Child lives with: Both Parents Mother Father Stepmother Stepfather (please circle) Other .................................. (please specify)

Custody Arrangements (if applicable):

First Names: Surname:

Relationship to Child: Phone:

Mobile: Email:

Residential Address:Post Code:

Name: Relationship to Child:

Phone: Mobile:

Name: Relationship to Child:

Phone: Mobile:

Name 1: DOB: Already attends KKPS Intending to Enrol (please circle)




(Original sighted)

SC

AN

NE

D

MEDICAL INFORMATION:

EARLY CHILDHOOD EDUCATION: please tick one

MILK FOR SCHOOLS:

LEARNING or HEALTH SUPPORT/FUNDING:

TRANSPORT please tick one

DECLARATION:

TE WHAKATUPURANGA : would you like your child to be in the Bilingual class?

Allergies:

Medical Conditions:

Medication:

Doctor’s Name:

Medical Centre: Phone:

Years/Months attended: Hours attended per week:

Name of Centre (new entrants only):

Name of Parent/Caregiver: Date:

Signature of Parent/Caregiver:

Bilingual Option (criteria applies - please see information booklet for further details) Yes No (please circle)

Is your child currently receiving extra support and / or funding at ECE or school? If you are unsure, please check with your current education provider. If yes, please explain:

Yes No (please circle)

If yes please circle:Special Ed / Oranga Tamariki / TRK (Te Roopu Kimiora)Speech Therapy RTLB / RTLIT / OT / Early Intervention

Kindergarten, Playcentre, Education & Care or Home based service.

Kohanga Reo

Pacific Islands Group or Playgroup

ECE Group, type unknown, including overseas

Did not attend any type of ECE Centre / Service

I would like my child to participate in Fonterra Milk for schools and receive milk in school Yes No

Pupil will walk to/form school Pupil will be dropped off/collected Pupil will catch bus

In terms of the Privacy Act, I understand that the information on this form is collected to form part of the essential information the school holds regarding my child. All information relating to this child can be used for school purposes and for the PTA or BOT. • I agree for my child’s work or photos to be published in school publications, both print and online, and on the

school website.• I give general consent for my child to participate in EOTC (Education outside the classroom) within a 2.6km radius of

the School during his or her normal classroom time allocation as approved by the Principal and EOTC Procedures.• I give consent for the school to take action on my behalf in case of sudden illness or injury,• I agree to abide by school policies and procedures, copies of which are available at the school office.• I agree to follow school policy and will send my child in regulation uniform as required from term 2, 2017.• I confirm that the information I have given in completing this form is true and correct.• I will notify the school office if I change address or contact information and complete any necessary documentation.• I/we have provided the school with up to date medical, supervision and learning information through the

enrolment form and will make every endeavour to keep this information current.• I understand that KKPS is a ‘water only’ School and agree to abide by this policy.

If you wish your child to use the School Bus, you must contact the Office and make arrangements BEFORE your child will be allowed to use the bus.

B4 School Check: Yes No If you answered yes please advise Hearing test: Pass Fail Eyesight test: Pass Fail

Further information:

Ko Wai Au? Who am I?

As part of getting to know your child before they start at Kerikeri Primary School, we ask if you could please fill this form out and give to the School Office. This form will then be passed on to your child’s teacher.

Child’s name: ________________________________________________________

Age: ______ ECE setting attended: _____________________________

What are some of the hopes and aspirations you have for your child while at Kerikeri Primary School?

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

What are your child’s interests?

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

What do you feel are your child’s strengths?

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Any further comments that you would like to share about your child:

__________________________________________________________________________________

__________________________________________________________________________________

__________________________________________________________________________________

Thank you, we appreciate you taking the time to share this information about your child. It will help us to better get to know your child at our school.

STUDENT INFORMATION CONSENT FORM revision 231117

To the parent/caregiver/legal guardian, please:

1. Sign the appropriate section on this form. 2. Detach and return the signed section to the school office.

3. Keep this document for future reference.

School Responsibilities

To protect students' privacy and safety in relation to information about them, or images of

them, published by the school, and protect students' copyright in relation to the material they

create.

Images of students and/or their work are published to recognise student achievement, report

on learning to the school and wider community, and to promote the school.

With consent, we share no more than a student’s first name, image, or work in the school

newsletter, on the school website, or in the wider online community.

The school publishes images and students' work that positively depict the student and school.

The school seeks students' consent before publishing their work.

As the author of a copyright work, a student has the right to be identified when their work is

exhibited in public, such as on the internet. At Kerikeri Primary School we prefer to identify

the student by their first name and year at school only to protect their privacy. Requests for a

child's full name to be published are considered by the Principal.

Student Images Images of our students (photographs, video clips, etc), and examples of their school work, are

sometimes published in our newsletters, on our school website, and other online channels such

as the school/class blogs, Facebook page, youTube, etc.

The purposes of publishing student material are to educate our students according to the

national curriculum, to encourage students to participate in our school community, and to

promote the school.

We believe it is important to celebrate children’s achievement, but are aware of the potential

risks when such personal information or material is published on a global information system

such as the Internet.

In the interest of safety and security we require parents to give permission for their child’s first

name, image, or work to be made public.

With consent, we share no more than a student’s first name, image, or work in the school

newsletter, on the school website, or in the wider online community.

Note: This agreement for your child will remain in force as long as he/she is enrolled at this school. If it becomes necessary to add/amend any information or rule, parents will be advised in writing. Parents are welcome to contact the school to discuss these issues.

ICT AGREEMENT revision 231117 Note: This agreement is additional to the student BYOD agreement. This agreement must be signed before the student may use information and communications technologies (ICT) and devices at Kerikeri Primary School


1. Read this page carefully with your child, to check that you both understand your responsibilities under this agreement.

2. Sign the appropriate section on this form. 3. Detach and return the signed section to the school office. 4. Keep this document for future reference.


At our school, we will: • Enhance learning through the safe use of ICT. This includes working to restrict access to

inappropriate, illegal or harmful material on the Internet or other ICT equipment/devices at school or through school-related activities

• Work with children and their families to encourage and develop an understanding of the importance of Cybersafety through education including providing children with strategies to help keep themselves safe when using ICT

• Respond to any breaches in ICT use in an appropriate manner; this may be the restriction of device use

• Welcome enquiries from parents or students about Cybersafety issues • Provide learning opportunities that are enhanced with the use of devices; however the use of

devices is at the teacher’s discretion and knowledge of appropriate learning; this may or may not be with the use of a device

• Provide internet access through the Kerikeri Primary School wireless network

Student Responsibilities

I will always be a good digital citizen. This means that I: • Will be a confident and capable user of ICT. I know what I do and do not understand about the

technologies that I use. I will get help where I need it • Will use ICT for learning as well as other activities. I understand that technology can help me to

learn. I also know it can be used to talk to people, to buy and sell things and to have my opinion heard. I know when and where it is OK to do each one

• Will think carefully about whether the information I see online is true. I know that it is easy to put information online. This means that what I see is not always right. I will always check to make sure information is real before I use it

• Will be able to speak the language of digital technologies. When people talk online the things they say can be quite different from a conversation they might have if they were sitting next to each other. I know that I must try to understand what people are saying before I react to them. If I am not sure, I can ask them or someone else to explain

• Understand that I may experience problems when I use technology but that I will learn to deal with them. I understand that there will be times when technology may not work as I expect it to, or that people may be mean or unkind to me online. When these things happen, I know that there are ways I can deal with it. I also know there are people I can go to, to get help if I don’t know what to do next

• Will always use ICT to communicate with others in positive, meaningful ways. I will always talk politely and with respect to people online. I know that it is possible to bully or hurt people with what I say and do on the internet. I will think about the effect that my actions have on other people

• Will be honest and fair in all of my actions using ICT. I will never do anything online that I know will hurt anyone. I will make sure what I do is not against the law. I will make sure that my actions don’t break the rules of the websites that I use. When I am not sure about what I am doing I will ask for help

• Will always respect people’s privacy and freedom of speech online. I understand that some information is private. I will be careful when using full names, birthdays, addresses and photos of other people and of my own. I also know that I will not always agree with what people say online but that does not mean that I can stop them or use it as an excuse to be unkind to them

• Will help other to become a better digital citizen. Being a good digital citizen is something that we all have to work at. If I know that my friends are having problems online, I will try to help them. If I see that someone is being unfairly treated online then I will speak up rather than just watch it happen

• Will ensure the responsible safe care of devise. If my thoughtless or irresponsible actions cause damage of a device, I may have to cover the cost of repair or replacement.

• Student Declaration I understand that these guidelines for responsible use are to be followed when using any technology whilst at school or whilst on any school activity. I am aware that this may include the use of a device that the school does not own.

I understand that if I breach this responsible use agreement, I may lose access to school ICT services including the use of the internet, on school owned devices or any personally owned device used at school. I will not use my device to be mean, rude, or offensive to anyone.

Parent Responsibilities

I understand that our school is supporting students as they learn the skills required to become successful digital citizens. Our school defines a digital citizen as someone who is a confident and capable user of ICT.

● uses technologies to participate in educational, cultural, and economic activities ● uses and develops critical thinking skills in cyberspace ● is literate in the language, symbols, and texts of digital technologies ● is aware of ICT challenges and can manage them effectively ● uses ICT to relate to others in positive, meaningful ways ● demonstrates honesty and integrity in their use of ICT ● respects the concepts of privacy and freedom of speech in a digital world ● contributes and actively promotes the values of digital citizenship

I understand that the school provides access to the internet and other communications technologies because it believes that they enhance the teaching and learning process.

I understand that the school encourages responsible behaviour by students when using technology to help protect themselves and each other from experiencing harm online. I am aware that this “Responsible Use Agreement” is part of that, and that it encourages students to consider how their actions can affect themselves and those around them.

I have read the student declaration and have talked with my child about what it means to them. I am happy that my child understands what this means, and that they are capable of working within the guidelines.

I am aware that students can experience challenges when using technology, but that the school makes every effort to support students to manage those challenges effectively. I understand that by learning to deal with them in a safe environment with the appropriate support they will be better prepared to deal with those challenges in the future.

If I have questions or concerns about the way in which technology is being used by my child at school, I know the school is happy to discuss this with me, and I am aware that I am welcome to do this at any time.

December 2017

BRING YOUR OWN DEVICE (BYOD) AGREEMENT revision 231117 Note: BYOD is optional, not compulsory, and the provision and use of a personal device for your child at school is entirely at your own discretion. This agreement is additional to the student ICT (Information and communication) agreement. It refers to digital devices brought to school by students, and must be signed before the student may bring the device to school.


1. Read this page carefully with your child, to check that you both understand your responsibilities under this agreement.

2. Sign the appropriate section on this form. 3. Detach and return the signed section to the school office. 4. Keep this document for future reference.


At our school, we will: • encourage safe and effective use of technology and the internet • work within the school's digital technology guidelines • provide clear guidelines around the use of devices brought from home • provide safe storage for students' devices when not at use, e.g. break times, Sports Days;

however the responsibility for using this facility will be the students.

If a student breaches the BYOD agreement, they may lose the privilege of bringing their own device to school, and the school's behaviour management plan may be invoked.

Student Responsibilities

When I bring my device to school I will: • follow the school's digital technology rules • use my device when and where the teacher gives me permission • only access the internet with the teacher's permission and if an adult is present • only use my own login and password • be in control of my device and not share it with other students, apart from letting them see

the screen • charge my device at home so that it doesn't need charging at school • follow procedures for storing my device safely in classrooms and take care of my device so

that it isn't damaged or stolen. • only use my device for learning • only use my device during the learning times at school (not before school or at break

times) I will not use my device to be mean, rude, or offensive to anyone.

Parent Responsibilities I give permission for my child to bring their device to school and I will:

• read and discuss this agreement with my child • encourage them to use it responsibly • take an interest in how they are using the device • be aware of the content and applications on the device • be responsible for the device's maintenance and insurance • take responsibility for the transportation of my child’s device to and from school • keep a record of the device's serial number and details • ensure that my child’s device is charged before bringing it to school • contact the school if I have any concerns about cybersafety or other related issues.

PLEASE SIGN AND RETURN TO SCHOOL AS SOON AS POSSIBLE Note: These permissions will remain in force as long as your child is enrolled at Kerikeri Primary School or until school is

notified in writing of any changes. If it becomes necessary to add/amend any information or rule, parents will be advised in writing.

BRING YOUR OWN DEVICE (BYOD) AGREEMENT (OPTIONAL YRS 3 – 6) revision 231117

I have read this Bring Your Own Device (BYOD) use agreement, and I am aware of the school’s initiatives to maintain a cybersafe learning environment, including my child’s responsibilities.

I have internet access at home: Yes No (please circle)

Student’s name Student’s signature

Parent/caregiver/ legal guardian’s name

Parent’s signature

Date ________________________________

ICT AGREEMENT (MANDATORY FOR STUDENT TO USE ICT AT SCHOOL)revision 231117

I have read the information & communications technologies (ICT) use agreement, and I am aware of the school’s initiatives to maintain a cybersafe learning environment, including my child’s responsibilities.

I have internet access at home: Yes No (please circle)

Student’s name Student’s signature

Parent/caregiver/ legal guardian’s name


Date

STUDENT INFORMATION PERMISSION revision 231117 Please indicate your wishes by ticking the relevant box:

I give permission for my child’s first name, image, or work to be published in the school newsletter, on the school website, or the wider online community.

I DO NOT give permission for my child’s first name, image, or work to be published in the school newsletter, on the school website, or the wider online community

I understand that I can withdraw this consent at any time by writing to the school.

Student’s name

Parent/caregiver/ legal guardian’s

name


Date

Evidence of Identity:The purpose of this section is to confirm the identity of the applicant to ensure the correct person is being vetted to a standard accepted by New Zealand Police for vetting purposes. This is based on identity confirmation requirements set out in the Children’s Regulations 2015.

In order to confirm the identity of the applicant, two forms of ID must be sighted, one primary and one secondary, one of which must be photographic.

Primary IDs include: Passport (NZ or Overseas)

NZ Firearms Licence

NZ Full Birth Certificate (issued on or after 19981)

NZ Citizenship Certificate

NZ Refugee Travel Document

NZ Emergency Travel Document

NZ Certificate of Identity

Secondary IDs include: NZ Driver Licence

18+ card

NZ Full Birth Certificate (issued before 1998)

Community Services card

SuperGold Card

NZ Employee Photo Identification Card

NZ Student Photo Identification Card

Inland Revenue number

NZ issued utility bill (issued not more than six

months earlier)

NZ Teachers Registration certificate

NZ Electoral Roll Record

International Driving Permit

Steps to Freedom Form

Current identity documents are preferred, but documents that have expired within the past five

years may be accepted.

If an applicant is unable to meet the requirements for evidence of identity, please contact the Police

Vetting Service at [email protected].

Evidence of a name change

If the two identity documents have different names (e.g. a birth certificate contains the applicant’s

maiden name and a driver licence contains their married name) evidence of a name change must

be sighted such as a marriage certificate or statutory declaration.

As part of Kerikeri Primary School policy, all parent volunteers working or assisting with children either in the classroom, on our school grounds or as part of an excursion must be police vetted. We invite you to complete this form as soon as possible to ensure that you are eligible to participate in the future.

Please contact the office if you have any questions.

Vetting Service Request & Consent Form

NZPVS-CS – 05/19

Page 2 of 5

Name of Approved Agency submitting vetting request:

Section 2: Applicant to complete and return to Approved Agency

*Denotes a mandatory field

Personal Information

Details (note: the name you are most commonly known by is your primary name)

*Family name (Primary):

Given name(s):

*Gender:(M) (F) (Other) *Date of birth:

(dd/mm/yyyy)

Place of birth: (Town/City/State)

*Country of birth

NZ Driver Licence number:

Previous names: If applicable, please include other alias or alternate names; married name if not your primary name; previous/maiden/name changed by deed poll or statutory declaration.

Family name First name Middle names

Permanent Residential Address

*Number/Street:

Suburb: Post Code:

*City/Town/Rural District:


NZPVS-CS – 05/19

Page 3 of 5

Section 3: Applicant to complete and return to Approved Agency Consent to release information

1. The New Zealand Police may release any information they hold if relevant to the purpose of this vetting request. This includes:

• Conviction histories and infringement/demerit reports

• Active investigations, charges and warrants to arrest

• Charges that did not result in a conviction including those that were acquitted, discharged without conviction, diverted or withdrawn

• Any interaction I have had with New Zealand Police considered relevant to the role being vetted, including investigations that did not result in prosecution

• Information regarding family violence where I was the victim, offender or witness to an incident or offence, primarily in cases where the role being vetted takes place in a home environment where exposure to physical or verbal violence could place vulnerable persons at emotional or physical risk.

• Information subject to name suppression where that information is necessary to the purpose of the vet

2. If I am eligible under the Criminal Records (Clean Slate) Act 2004, my conviction history will not be released unless:

a. Section 19(3) of the Clean Slate Act applies to this request (exceptions to the clean slate regime)

b. Section 31(3) of the Children’s Act 2014 applies to this request (safety checks of core children’s workers).

c. The vetting request is made by an individual for the purpose of an overseas Visa/Work Permit as a Privacy Act

request authorising the vetting result to be provided directly to the relevant embassy, high commission or

consulate.

Please see the guide for more information regarding the Clean Slate legislation.

3. The Police Vetting Service may disclose newly-obtained relevant information to the Approved Agency after the completion of the Police Vet in the following circumstances:

• The disclosure of the newly-obtained information is considered to be justified under the Privacy Act 1993 (if it had existed or been available at the time of the Police vet, it would have been disclosed); and

• The Police Vetting Service has taken steps to confirm that the purpose of the Police vet still exists – e.g. that I got the role which required a Police vet and am still employed or engaged in it.

The Vetting Service will endeavour to notify you prior to the disclosure.

4. Information provided in this consent form may be used to update New Zealand Police records.

5. I am entitled to a copy of the vetting result released to the Approved Agency (to be provided by the agency) and can seek a correction by contacting the Vetting Service.

6. The Approved Agency will securely dispose of this consent form, copies of identification documents and the vetting result within 12 months of receiving the result unless a longer retention period is required by legislation.

7. I may withdraw this consent, prior to Police’s disclosure of the vetting result, by notifying the Approved Agency.

For further information, please see the Guide to Completing the Consent Form.

Applicant’s Authorisation:

✓ I confirm that the information I have provided in this form relates to me and is correct.

✓ I have read and understood the information above.

✓ I authorise New Zealand Police to disclose any personal information it considers relevant to my application (as described above) to the Approved Agency making this request for the purpose of assessing my suitability at any time.

Name: Date:

Signature:

Electronic Signature


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Section 4: Applicant to complete for Australian check (if required)

Additional Personal Information (for Australian National Police History Check) Last Permanent Australian Residential Address

*Number/Street:

*Suburb: *Post Code:

*City/Town/ Rural District:

*State or Territory:

*Period of Residence Start date (dd/mm/yyyy)

*Period of Residence End date (dd/mm/yyyy)

Australian Driver's Licence No: (if applicable)

Issued by:

Australian Firearms Licence No: (if applicable)

Issued by:

General Information for an Australian National Police History Check General Information Australian Criminal Intelligence Commission (ACIC) is collecting your personal information in this form in order to conduct a National Police History Check (NPHC) on you. Approved Agencies in New Zealand, named in section one, use the personal information collected on this form and the resulting NPHC as part of the assessment process to determine suitability for the position/entitlement/benefit which you are applying for.

Unless statutory obligations require otherwise, the information provided on this form will not be used without your prior consent for any purpose other than in relation to the assessment of your suitability or to maintain the records of ACIC,

Australian Police Agencies1, or NZ Police.

You will be required to complete another consent form for any future NPHC checks.

National Police History Check (NPHC) A NPHC is an integral part of the assessment of your suitability. Information on this form will be used by ACIC, and Australian Police Agencies for checking action; it will also be used to update records held about you by ACIC, Australian Police Agencies and NZ Police. Information released may include outstanding charges, warrant information and criminal convictions/findings/pleas of guilt recorded against you that may be disclosed according to the laws of the relevant jurisdiction and, in the absence of any laws governing the release of that information, according to the relevant jurisdiction information release policy.

Limitations on accuracy and use of Police History Information While every care has been taken by ACIC to conduct a search of information held by Australian Police Agencies that relate to the applicant, the accuracy and quality of this NPHC depends on accurate identification of the Applicant (including aliases) according to the information provided in the Request and Consent Form and the comprehensiveness of police records. If the applicant does not complete the information requirements in this form the success and validity of the NPHC will be compromised.

If for any reason you do not agree with the results of your NPHC, please notify the Approved Agency that you submitted the check through in the first instance, so that the NPHC dispute process can be initiated.

The release of information by Australian Police Agencies is subject to relevant Spent Convictions, non-disclosure legislation or information release policies. Spent Conviction Schemes The aim of Spent Convictions legislation2 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. Each Australian Police Agency will apply the relevant Spent Convictions legislation/information release policy prior to disclosure.

General Information for an Australian National Police History Check, (continued)

1 2


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The following links may be helpful in sourcing information on Spent Convictions in the Australian States & Territories but may not be relied upon. If further information or clarification is required please contact the individual Australian Police Agencies directly for further information about their release policies and any legislation that affects them.

Commonwealth www.comlaw.gov.au New South Wales www.legislation.nsw.gov.au Queensland www.legislation.qld.gov.au

South Australia www.legislation.sa.gov.au Victoria Police www.police.vic.gov.au Tasmania www.thelaw.tas.gov.au

Western Australia www.slp.wa.gov.au Northern Territory -www.nt.gov.au/dcm/legislation/current.html Australian Capital Territory www.legislation.act.gov.au

Provision of incomplete, false or misleading information An Approved Agency or Applicant must take reasonable steps to ensure that the personal information collected, or disclosed is accurate, complete and up to date.

You are asked to certify that the personal information you have provided on this form is correct. If it is subsequently discovered, for example as a result of a check of police records, that you have provided incomplete, false or misleading information, you may be assessed as unsuitable.

It is a serious offence to provide false or misleading information in Australia.

Consent to disclosure (for Australian National Police History Check) 1. I have read the General Information in section 3 of this form and understand that information will be disclosed in

accordance with applicable legislation and information release policies (including spent convictions legislation, however described) in the Commonwealth, States and Territories;

2. I understand that the position/entitlement for which I am being considered may be in a category for which exclusions from Spent Convictions legislation may apply;

3. I have fully completed this form, and the personal information I have provided in it relates to me, contains my full name and all names previously used by me, and is correct;

4. I acknowledge that the provision of false or misleading information is a serious offence;

5. I acknowledge that the Approved Agency named in Section 1 of this form is collecting information in this Form to provide to New Zealand Police to provide to ACIC (an Agency of the Commonwealth of Australia) and the Australian Police Agencies;

6. I consent to: a. ACIC using and disclosing personal information about me in this form to the Australian Police Agencies;

b. the Australian Police Agencies disclosing to ACIC, from their records, Police History information that can be disclosed in accordance with the laws of the Commonwealth, States and Territories and in accordance with the relevant jurisdiction’s information release policies;

c. ACIC disclosing the information disclosed by the Australian Police Agencies to New Zealand Police, and

d. New Zealand Police disclosing any criminal history information about me to the Approved Agency named in Section 1 of this form to assess my suitability in relation to my application;

7. I acknowledge that any information provided by me in this form relates specifically to the purpose identified in Section 1 of this form;

8. I acknowledge that any information provided by the Australian Police Agencies or ACIC relates specifically to the purpose identified in Section 1 above;

9. I acknowledge that personal information that I provide in this form may be disclosed to the Approved Agency named in Section 1 of this form (including contractors or related bodies corporate) located in New Zealand or overseas; and

10. I acknowledge that it is usual practice for an Applicant's personal information in this form to be disclosed to New Zealand Police and Australian Police Agencies for them to use for their respective law enforcement purposes including the investigation of any outstanding criminal offences.

Note: The information provided in this form will be used only for the purpose stated above unless statutory obligations require otherwise.

Applicant’s Authorisation:

I have read and understood the information above and consent accordingly. Signed in electronic form

or, Signature: ____________________________ Date:

Welcome to Kerikeri Primary School, please find enclosed … · 2020-02-03 · As part of getting...

Documents

Transcript of Welcome to Kerikeri Primary School, please find enclosed … · 2020-02-03 · As part of getting...