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Accept the Terms and Provide Consent
acknowledge that I/the applicant understand the information on this form.
acknowledge that the accredited body named C1 is collecting information in this form to provide to the Australian Criminal Intelligence Commission (ACIC) and police agencies, for a nationally coordinated criminal history check to be conducted for the purpose outlined in Section B of this form.
have fully and accurately completed this form, and the personal information I/the applicant, have provided relates to me/the applicant, and contains the full name and all names previously used by me/the applicant.
acknowledge that withholding and/or providing misleading or false information on this form and in any supplied identity documents is a Commonwealth offence and may lead to prosecution under the Criminal Code Act 1995 (Cth).
acknowledge that personal information that I/the applicant provided in this form and on the supplied identity documents may be disclosed to the accredited body named in Section C of this form (including contractors, legal entity customers, related bodies or third parties named in C1 of this form in Australia or overseas, if applicable).
acknowledge that any information sent by mail or electronically, in relation to this form, including identity documents, is sent at my/the applicant’s risk and I/the applicant, am aware of the consequences of sending information in these ways.
acknowledge that I/the applicant am aware that I/the applicant am providing consent for a national check to be conducted on all personal information provided in this form and provided in suppled identity documents.
understand and consent to police information relating to me/the applicant, being disclosed in accordance with the purpose identified in section B of this form, applicable legislation and information release policies (including spent convictions legislation described in Australian Government and state or territory legislation).
give consent to:
a) the ACIC and police agencies using and disclosing my/the applicant’s personal information that I/ the applicant, have provided in this form and personal information contained in my supplied identity documents to conduct a nationally coordinated criminal history check.
b) the ACIC disclosing the police information sourced from the police agencies to other approved bodies and the accredited body named in C1 of this form.
c) the accredited body named in C1 of this form disclosing to the legal entity customer, third parties and any permitted offshore transfer arrangements also detailed in C1, my/the applicant’s personal information and police information to assess my/the applicant’s suitability for the purpose identified in section B of this form.
acknowledge that it is usual practice for my/the applicant’s personal information and police information to be used by police agencies and the ACIC for law enforcement, including purposes set out in the Australian Crime Commission Act 2002 (Cth).
I have read the terms listed above and consent to the PharmacyID undertaking a National Police History Check on my behalf.
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