certificate in health and fitness entry · pdf filetotal credits 60 (minimum) ... the...

Information for International applicants

CERTIFICATE IN HEALTH AND FITNESS

Qualification Certificate in Health and Fitness

Programme level Level 3

Length 17 weeks

Start dates 20 February and 24 July

Study options Full-time

FeesNZ$ 10,800 Please see overleaf for additional costs

Total credits 60 (minimum)

Class timesClasses are scheduled between 9.00am and 3.00pm, Monday - Thursday

LocationNapier Campus Gisborne Campus

ContactInternational Centre Phone: +64 6 974 8902 Email: [email protected]

The Certificate in Health and Fitness is a 17 week full-time programme which offers you stimulating studies and provides a pathway to a career in the wide field of recreation, sport, health, fitness and leisure.

In particular, the programme is designed to enable a student to:

• Integrate knowledge of the relationship between nutrition, physical activity and other personal health behaviours and health.

• Plan and organise active recreation, sport and fitness programmes.

• Apply knowledge of human anatomy to exercise techniques and stretches.

2017 ENTRY

JOB OPPORTUNITIESFor trained fitness and recreation professionals, employment opportunities are varied and exciting.

Possible jobs and career opportunities can include:

• Exercise Consultant (Level 1)• Community Recreation Assistant• Community Health Programmes Assistant The Register of Exercise Professionals (REPs) operates a registration body for exercise professionals, exercise facilities and education providers in New Zealand. On successful completion of the Certificate in Health and Fitness students will be able to register with REPs as:

• Exercise Consultant (Level 1) • Group Exercise Instructor

international.eit.ac.nz SEP

20

16

STUDENT PROFILE

Name Rynold TimothyCountry India

“I chose EIT because it’s one of the most recognised colleges in the country and is well known for the course I pursue, the Bachelor of Recreation and Sport. It was my understanding that a lot of top athletes from around Hawke’s Bay and nearby regions are students of this sports programme. The constant interaction with the other athletes in class helped me realise the value of sport for the New Zealand people. The Bachelor of Recreation and Sport is very interactive. The teachers are highly qualified, motivating and friendly and they have helped me in times of difficulties without any hesitation."

ENTRY REQUIREMENTSThe Certificate in Health and Fitness is an open entry Programme which means no formal academic qualifications are required. Students must be aged 18 years and over.

INFORMATION SESSION

An information session is recommended as it is an opportunity for us to clarify what is involved in the programme and you as a potential student to make sure the programme is right for you.

HEALTH AND PROFESSIONAL CRITERIA

All applicants are required to:

• Sign a declaration and a request for personal information held on the Police computer

• Sign a declaration that they are in good health (having no medical, physical or psychological conditions that would preclude working with vulnerable clients).

This is request is consistent with industry expectations and the type of work undertaken whilst on the programme or as a graduate of the programme.

ENGLISH LANGUAGE ENTRY REQUIREMENTS

Applicants for whom English is not their first language must have an acceptable level of English language fluency prior to enrolment in the programme. This may be demonstrated in a variety of ways, including successful study of a programme in which English was the language of instruction, completion of a New Zealand Certificate in English Language (Level 3), approved scores on IELTS tests (5.0 Academic in all bands or equivalent), completion of accepted international equivalents, or completion of an EIT assessment.

FACILITIES

NAPIER CAMPUS

Lectures are held at EIT’s Napier Campus and in the Pettigrew.Green Arena. Both venues offer students industry standard facilities. Students complement their studies with access to the EIT Sport Science Laboratory for fitness testing.

ARENA GYM

Included in the enrolment for the Certificate Health and Fitness is a limited membership to the gym facilities. Further details will be provided on acceptance into the programme.

GISBORNE CAMPUS

Lectures are held at EIT Gisborne Campus and practical sessions are held at the YMCA.

PRACTICUM/WORK EXPERIENCEStudents work closely with a wide range of health, fitness and recreation providers to complete projects, assignments and practicum experiences.

ASSESSMENTSAssessments include: Practical skill assessment, , written reports, assignments and a portfolio.

PARTNERSHIPS• Sport Hawke’s Bay

• Pettigrew.Green Arena

• Sport Gisborne

• YMCA Gisborne

ACADEMIC STAFFWe value our partnership with students and aim to provide quality education in a supportive environment, encouraging personal growth and professional development.

CERTIFICATE IN HEALTH AND FITNESS

NAME QUALIFICATION

Ashleigh Seagar Programme Coordinator / Lecturer

Certificate in Health and Fitness / Trades Academy

EIT Tairāwhiti Campus

Dip Fitness Testing, Dip Performing Arts

Nikki Wawatai Lecturer

Certificate in Health and Fitness, EIT Taradale Campus

Bachelor of Sport and Exercise

RECOGNISED BY THE REGISTER OF EXERCISE PROFESSIONALS (REPS) AT THE LEVELS OF: FOUNDATION LEVEL EXERCISE ASSISTANT, GROUP

EXERCISE INSTRUCTOR, AND EXERCISE CONSULTANT (LEVEL 1).

COURSE BRIEF DESCRIPTION CREDIT VALUE

NZQA LEVEL

NZQA 505 Manage personal physical fitness and guidance. 3 1

NZQA 6402 Provide resuscitation. 1 1

NZQA 6400 Manage first aid in emergency situations. 2 3

NZQA 6401 Provide first aid. 2 2

NZQA 6571 Demonstrate relevance of principles of nutrition to health. 2 2

NZQA 21791 Relate human anatomy and movement to gym equipment and static stretching. 4 2

NZQA 21792 Demonstrate knowledge of health risk factors and disease and monitor exercise street. 4 2

NZQA 21793 Demonstrate correct technique when using basic gym equipment. 2 2

NZQA 21794 Demonstrate, instruct and monitor static stretching. 3 2

NZQA 21795 Demonstrate, instruct and monitor safe and correct use of cardiovascular exercise equipment. 3 2

NZQA 7038 Explain the purpose and structure of a fitness enterprise. 4 3

NZQA 1304 Communicate with people from other cultures. 2 3

NZQA 7042 Advise individual client on health, fitness, exercise and lifestyle. 5 3

NZQA 22772 Demonstrate knowledge of exercise, motivation and the structure of group fitness classes. 12 3

NZQA 7016 Monitor and promote client security, comfort, enjoyment and learning in fitness and/or recreation. 3 3

NZQA 4864 Identify recreational needs of specified populations. 4 3

NZQA 7021 Demonstrate exercise techniques. 8 3

COURSE DESCRIPTIONS

CERTIFICATE IN HEALTH AND FITNESS 2017

DOCUMENTATION / FORMS

Please Note The following documents need to be completed and returned with

your application.

Without these documents we are unable to proceed with your application

• Brief Personal Statement including Brief CV/Work History

• Referee Form

• Police Clearance Certificate

• Health Declaration Form

CERTIFICATE IN HEALTH AND FITNESS 2017PERSONAL STATEMENT

(Handwritten please)

Please tick which campus you are intending to study the programme on:

Napier Campus Gisborne Campus

Name: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

1. What do you believe are your personal strengths?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

2. Why are you interested in studying the Certificate in Health and Fitness ?

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

_________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

3. As part of this programme you may have practical experiences with agencies or organisations who may require you to obtain a police vet of your personal information for any criminal convictions, criminal history, and details of fines and enforcements and/or hold a current First Aid Certificate.

Have you ever had a criminal conviction?

Yes No

Please note: A prior conviction may not necessarily exclude you from acceptance into the programme, but we may need to discuss it with you.

Do you have a First Aid Certificate that includes NZQA Unit Standards 6401, 6402 and 6400 or please list other First Aid Unit Standards. A First Aid Certificate is valid for two years from date of issue.

Yes (a copy of this will need to be provided at time of application)

No

If you do not hold a current First Aid Certificate you will have an opportunity to gain this as part of the programme.

Signed: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

REFEREE FORMCERTIFICATE IN HEALTH AND FITNESS 2017

You are also required to ask one (1) referee to complete the Referee form.

1. Please advise your referee to email [email protected] directly.

• If you are still attending school (or have recently left) it is ideal to have as your referee the Principal of that school.

• If you are (or have been) employed, please endeavour to have as your referee a recent employer.

2. Family members are NOT considered appropriate referees.

To the Applicant: Please fill in your referee's name and address below and give this form to your referee as soon as possible.

(It is recommended that you contact your referee to obtain their permission.) Be sure you fill in your name below.

Applicant's Name: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

please print

To the Referee: This is a CONFIDENTIAL Reference Form.

The information given will be held in the strictest confidence and will assist in the selection process.

For EIT Hawke's Bay

Please complete this page and email to [email protected]

You may be contacted with regard to the suitability of the applicant.

Thank you for your assistance.

I give permission to be contacted.

Signed: __________________________________________________________________________________________________________________________________________________________________________________________________________ Date: ____________________________________________________________________________________

Referee's Name: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

please print

Address: ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Phone: ___________________________________________________________________________________________________________________________________________

CERTIFICATE IN HEALTH AND FITNESS 2017HEALTH DECLARATION

Please tick which campus you are intending to study the programme on:

Napier Campus Gisborne Campus

Should you have any questions about the level of health required to complete this programme please contact the

programme coordinator prior to completing this declaration.

I declare that I have no medical, physical or psychological conditions that would significantly impact on my ability to

participate in the practical and theory components of this programme. Should my health status change dramatically during

my study I confirm I will make the programme coordinator aware of this change.

Signed: __________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Date: _______________________________________________________________________________________________________________________________________________

Vetting Service Request and Consent Form

NZPVS‐CS ‐ 07/15

Page 1 of 7

Section 1: Approved Agency to complete

Name of Applicant to be vetted:

Name of Approved Agency submitting vetting request:

E70351 - EIT Hawke's Bay

New Zealand Police Vet only Sections 1 & 2 to be completed

New Zealand Police Vet & Australian National Police History Check Sections 1 ,2 & 3 to be completed

APPLICANT’S ROLE – PURPOSE OF VET Employee Contractor/Consultant Volunteer Prosecution

Vocational Training Licence/Registration Visa/Work Permit Other: (please specify here)

Description of Applicant’s role / licence / registration (e.g. caregiver; cleaner; taxi driver; teacher; etc):

Health & Fitness Student

What group(s) will the applicant have contact with in their role for your agency?

Children/Youth Elderly Other Vulnerable Adults Other: (please specify here) What is the applicant’s primary role for your agency?

Care & Protection (Children/Youth) Care & Protection (Elderly/Vulnerable Adults) Education

Healthcare Other (please specify here)

Is this request mandatory under the Vulnerable Children Act 2014 (VCA)?

Yes( VCA Core Worker) Yes( VCA Non‐Core Worker)

No (mandatory under other legislation/optional/standard Police Vet)

Please note the NZ Police Vetting Service cannot provide any guidance as to whether requests are subject to the Vulnerable Children Act 2014. For information on this please see www.childrensactionplan.govt.nz.

If this is a mandatory Vulnerable Children Act request, please specify the check reason below:

New Children’s Worker: Applicant is working for the first time in your organisation in a children’s worker role.

Existing Children’s Worker: Applicant currently works for your organisation in a children’s worker role.

VCA Renewal: Subsequent vetting request for an existing children’s worker, required once every three years.

Application of the Criminal Records (Clean Slate) Act 2004: The NZ Police Vetting Service must comply with the Criminal Records (Clean Slate) Act 2004. Your answers to the above questions will assist us in determining what section of the Act applies to this vetting request. Section 16 (Clean Slate): Conviction history will not be released if applicant is eligible for clean slate. The role does not fit the criteria in section 19(3) of the Criminal Records (Clean Slate) Act, e.g. teacher, doctor/nurse, rest home carer. Section 19(3) (Exception): All criminal convictions will be released EVEN IF the applicant is eligible for clean slate. The role fits the criteria of one or more of the exceptions in section 19(3) of the Criminal Records (Clean Slate) Act

e.g. it is a role predominantly involving the care and protection of, but not predominantly involving the delivery of education to, a child or young person (e.g. caregiver, nanny, foster/homestay parent, applicant for adoption) [section 19(3)(e)].For information on the clean slate regime, see http://www.justice.govt.nz/services/criminal‐records/about‐the‐criminal‐records‐clean‐slate‐act‐2004.



Page 2 of 7

Section 1 continued: Approved Agency to complete

EVIDENCE OF IDENTITY (ID) ‐ for further information, see http://www.dia.govt.nz/Resource‐material‐Evidence‐of‐Identity‐Standard‐Index

I confirm that the identity of the applicant has been checked by [A] or [B] as follows:

[A]

I have (or my delegate has), OR, A Trusted Referee* has sighted the ID documents below, and verified the photo against the applicant in

person (mark box)

Primary ID document (e.g. passport, original birth certificate, firearms licence, etc; see link above)and

Another form of ID (e.g. driver licence, 18+ card, Community Services Card, etc; see link above) and

One of the above must be photographic – confirm comparison made and, if applicable

Evidence of name change where names differ (e.g. marriage/civil union certificate, statutory declaration, etc)

[*a trusted referee must be over 16, and not be related, or a partner/spouse, or a co‐resident of

applicant, and be either a person of standing in the community (e.g. registered professional, religious or community leader) or registered with the Approved Agency. The Trusted Referee must sign a copy of the photo ID and provide his or her name and contact details.]

Optional additional check by me (if appropriate)

A search of our records to verify uniqueness (especially for professional bodies)

[B] I have received an assertion of a RealMe verified identity ‐ limited to agencies who are able to use RealMe to verify identity ‐ for further information, see https://www.realme.govt.nz/

CHECKLIST In making this request, I confirm that:

I have complied and will comply with the Approved Agency Agreement (or existing Memorandum of Understanding) between NZ Police and the Approved Agency I represent;

I am satisfied as to the correctness of the Applicant’s identity (if applicable I confirm that Trusted Referee contact details have been provided); and

I have obtained the Applicant’s authorisation to submit this vetting request, as set out in section 2 of this form.

Approved Agency Authorised Representative:

Name: Date:

Signed in electronic form: [mark box]

OR Signature:

* a Trusted Referee must be over 16, and not be related, or a partner/spouse, or a co-resident of the applicant, and be either a person of standing in the community (e.g. registered professional, religious or community leader, Police employee) or registered with the Approved Agency. The Trusted Referee must:

1. sign and date the copies of identity documents, and endorse each of them appropriately e.g.• "I have sighted the original version of this document"• I have sighted the original version of this document and I have compared the photographic image with

(name of applicant) and confirm they apear to be the same person."

2. provide her is his name and contact details

etc



Page 3 of 7

Name of Approved Agency submitting vetting request: E70351 - EIT Hawke's Bay

Section 2: Applicant to complete and return to Approved Agency (the Approved Agency will submit the vetting request to NZ Police and receive the vetting result)

PERSONAL INFORMATION Details (note: the name you are most commonly known by is your primary name) *Family name: (Primary)

First name(s):(Primary)

*Gender:

(M) (F) (Other)

*Date of birth:(dd/mm/yyyy)

*Place of birth: (town/city/state)

*Place of birth: (country)

NZ Driver Licence number: (*where held ‐ for ID verification by NZ Police)

If applicable, please include other names and mark them A, M, or P as appropriate:

(A) alias or alternate name(s) (M) married name if not primary name (P) previous/maiden/name changed by deed poll or statutory declaration

Family name: (A) (M) (P)

First name(s):(A) (M) (P)







Permanent New Zealand Residential Address *Number/Street:

Suburb: Post Code:

*City/Town/ Rural District: *Period of

Residence:

*Denotes a mandatory field



Page 4 of 7

Section 2: continued

Applicant to complete and return to Approved Agency (the Approved Agency will submit the vetting request to NZ Police and receive the vetting result)

CONSENT TO DISCLOSURE (for a New Zealand Police Vet) ‐ for further information, see http://www.police.govt.nz/advice/businesses‐and‐organisations/vetting

I acknowledge and understand as follows: 1. The information about me that NZ Police may consider relevant to my application and release in vetting comprises

any conviction history and, for certain agencies, infringement/demerit reports; and it may include any other information such as active charges and warrants to arrest, any information received or obtained by NZ Police, and any interaction I have had with NZ Police in any context (including family violence), even where I have not been charged, or charges are withdrawn, or I have been acquitted (not guilty) of a charge, or I have been discharged without conviction.

2. Any conviction history will be released in accordance with the Criminal Records (Clean Slate) Act 2004; this means that, if I am ‘eligible’ for clean slate (e.g. no convictions for 7 years, never been to prison, no convictions for specified sexual offending, etc – see section 7 of the Act): a. my criminal record of convictions will not be disclosed; but

b. if the role for which I have applied is an exception to the clean slate scheme (e.g. predominantly involving care and protection of a child or young person), my criminal record of convictions will be disclosed.

3. Where relevant information is subject to statutory or Court‐ordered name suppression or prohibitions on disclosure, or other constraints on disclosure such as expectations of confidentiality or the protection of active criminal investigations or the safety of individuals, NZ Police may issue an alternative vetting result stating the existence of relevant non‐disclosable information, without details.

4. Where new information is obtained by NZ Police after the completion of my Police vet, NZ Police may disclose this information to the Approved Agency, and where appropriate to the Vulnerable Children Act Exemptions Administrator, if the information is considered relevant to the purpose of the Police vet.

5. The personal information I provide in this form is being collected for vetting purposes, and may also be used for the purpose of updating NZ Police records.

6. I may withdraw this consent, prior to Police’s disclosure of the vetting result, by notifying the Approved Agency who will immediately notify NZ Police to cease the vetting process (any fee remains payable by the Approved Agency).

7. I am entitled to access the vetting result released to the Approved Agency and seek correction of Police information about me in accordance with the Privacy Act 1993 by making a request to the 'Approved Agency' in the first instance.

8. No later than twelve months after the release of the vetting result, the Approved Agency will securely dispose of this consent form and copies of identification documents, as well as the vetting result released by NZ Police, unless a longer retention period is required by legislation applying to the Approved Agency.

9. The information I have provided in this form relates to me and is correct.

Applicant’s Authorisation:

I have read and understood the information above

I authorise NZ 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.


OR Signature:

Date:



Page 5 of 7

Section 3: 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

If actual dates of residence are unavailable, year of residence will suffice Australian Driver's Licence No: (if applicable) Issued by: Australian Firearms Licence No: (if applicable) Issued by: CONSENT TO DISCLOSURE

General Information for an Australian National Police History Check

GENERAL INFORMATION CrimTrac 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 CrimTrac, 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 CrimTrac, and Australian Police Agencies for checking action; it will also be used to update records held about you by CrimTrac, 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 CrimTrac 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.

1

Australian Federal Police, ACT Policing, The New South Wales Police Force, Queensland Police Service, South Australia Police, Victoria Police, Western Australia Police, Northern Territory Police Force, Tasmania Police Service



Page 6 of 7

General Information for an Australian National Police History Check, continued

SPENT CONVICTIONS 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.

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

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

Tasmania www.thelaw.tas.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.

2

Applicable Spent Conviction legislation, as amended from time to time



Page 7 of 7

Section 3: continued Applicant to complete for Australian check (if required)

CONSENT TO DISCLOSURE (for Australian National Police History Check) I acknowledge, understand and consent as follows:

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 NZ Police to provide to CrimTrac (an Agency of the Commonwealth of Australia) and the Australian Police Agencies;

6. I consent to:

a. CrimTrac using and disclosing personal information about me in this form to the Australian Police Agencies;

b. the Australian Police Agencies disclosing to CrimTrac, 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. CrimTrac disclosing the information disclosed by the Australian Police Agencies to NZ Police, and

d. NZ 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 CrimTrac 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 NZ 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


OR Signature:

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