APPLICATION FOR REGISTRATION

Notification to the Victorian Institute of Teaching under Section 19 of the Mutual Recognition

Act 1992 (Cth) or Section 18 of the Trans Tasman Mutual Recognition Act 1997 (Cth)

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WHICH APPLICATION FORM SHOULD I USE?

All application forms for registration are available in screen writable format on the forms page of the Institute’s website at www.vit.vic.edu.au

Please read these instructions carefully. Failure to correctly complete this application and pay the approved fees will delay the processing of your registration.

1 I have four years of approved higher education study, including an approved program of initial primary or secondary teacher education, from Australia or overseas.

You should complete form A:

Form A – Application for Registration to Teach (Part A)

Teachers who have completed 80 or more days of teaching experience post-qualification as a teacher should also complete Part B – Professional Practice Reference for Experienced Teachers

2 I am a provisionally registered teacher. I have completed the evidence-based process and I wish to apply for full registration.

You should complete form C:

Form C – Application for Full Registration for Teachers who are Provisionally Registered

3 I have three years of approved higher education study, including an approved program of initial primary or secondary teacher education, and I wish to work as a casual relief teacher.

You should complete form D:

Form D – Application for Permission to Teach

4 I am not fully qualified to be a teacher but I am being offered employment to undertake the duties of a teacher in a primary, secondary or special education school.

You should complete form D:

Form D – Application for Permission to Teach

5 I am currently registered with a teacher registration authority in Queensland, South Australia, Tasmania, Western Australia, the Northern Territory or New Zealand.

You should complete form E:

Form E – Application for Registration under Mutual Recognition

1 INFORMATION FOR TEACHERS APPLYING UNDER MUTUAL RECOGNITION ACTS

MUTUAL RECOGNITION PRINCIPLE

The Mutual Recognition Principle is that a person who is registered for an occupation* in the first state** is entitled to registration in the second state, for the equivalent occupation.

*an occupation is defined as a profession that may be carried on by registered persons only.**state includes an Australian State or Territory and New Zealand.

To qualify for registration under the Mutual Recognition Principle, you must:

complete this application form.

AND

provide evidence that you are currently registered with a teacher registration authority in an Australian State or Territory and are applying for registration in Victoria under the Mutual Recognition Act 1992 (Cth)

OR

provide evidence that you are currently registered in New Zealand and are applying for registration in Victoria under the Trans Tasman Mutual Recognition Act 1997 (Cth).

You will be deemed registered with a condition (see Part 3) in Victoria from the date your completed application is received by the Victorian Institute of Teaching (the Institute).

The Institute then has one month to decide whether to grant (with or without any conditions), postpone (for up to six months) or refuse your substantive registration (see Part 3). During this time, the Institute will take steps to verify the accuracy of the registration information provided by contacting the relevant teacher registration authority.

Once the Institute has verified the accuracy of the information provided by contacting the relevant teacher registration authority, the Institute will notify you in writing when a decision is made to grant, postpone or refuse substantive registration.

If you are granted substantive registration, there will be a condition (see Part 3) placed on your substantive registration relating to the payment of the approved fees (see Part 4). This will be lifted once the fee has been paid, after which time you will be sent a registration card.

If you do not pay the approved fee, you will not be issued with a teacher registration card and will not be permitted to teach in any Victorian primary, secondary or special education school in Victoria.

2 THE EDUCATION AND TRAINING REFORM ACT 2006

The Victorian Institute of Teaching (the Institute) is a statutory authority for the regulation of the teaching profession in Victoria established by the Victorian Institute of Teaching Act 2001. This Act was repealed with the proclamation of the Education and Training Reform Act 2006 on 1 July 2007. The Institute continues under and subject to the Education and Training Reform Act 2006 after 1 July 2007.

Only a person who is registered as a teacher, or who holds permission to teach with the Institute, can undertake the duties of a teacher in a Victorian primary, secondary or special school.

Under the Mutual Recognition Principle a teacher registered in the first state is entitled to seek registration in Victoria based on their registration in the first state. Once the teacher is substantively registered in Victoria, they have the same rights and obligations of any other registered teacher. However, if the registration authority in the first state takes action against the teacher on disciplinary grounds, the Institute may also take action against the teacher.

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3 REGISTRATION UNDER MUTUAL RECOGNITION

Deemed registration: Deemed registration is granted when you first lodge your completed application under the Mutual Recognition Principle. However, it is a condition that you must pay the approved fees and be issued with a teacher registration card before you can undertake the duties of a teacher.

Substantive registration: Substantive registration is the equivalent to registration as a teacher under the Act. Substantive registration is granted within one month of being granted deemed registration if all requirements are satisfied. The condition that you must pay the approved fees still applies. You are not permitted to undertake the duties of a teacher until you have been issued with a teacher registration card from the Institute and your name appears on the public Register of Teachers.

Conditions on registration: If a condition has been placed on your registration by your current teacher registration authority, the Institute may also impose the condition on your registration as a teacher in Victoria.

A condition will also be placed on your deemed and substantive registration in Victoria relating to the payment of the approved fees (see Part 4 below).

If you have full registration with your current teacher registration authority, you will be granted full registration with the Institute.

If you have provisional registration with your current teacher registration authority, you will be granted provisional registration with the Institute.

For further information on provisional and full registration, please refer to the Institute’s website at < www.vit.vic.edu.au>

4 FEES FOR REGISTRATION

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Under Section 2.6.77 of the Act, The Minister, ...may, by Order, fix any fee that is required or permitted to be fixed under this Part. Section 2.6.7(2)(iii) of the Act states that any application for registration must be accompanied by the prescribed fee.

On receipt of your application, an invoice including details of payment options available will be generated and forwarded to you. Please do not include payment when submitting the application.

The schedule of current registration fees is available at www.vit.vic.edu.au or by contacting the Institute on 1300 888 067.

If you do not pay the approved fees, you will not be able to teach in any primary, secondary or special school in Victoria.

5 COMPLETING YOUR APPLICATION

Applicants should ensure that all relevant sections of the application are completed before lodging it with the Institute.

To enable the Institute to record accurate information on the Register of Teachers, please attach certified copies of academic transcripts for all qualifications completed, together with evidence of completion (e.g. graduation certificate). This should include transcripts for units completed elsewhere which counted towards the final qualification. If you are unable to provide these documents with this application form, you will be required to submit them at a later date.

Any document you supply to support your application must be a certified copy of the original document.

In some circumstances, the Institute may wish to sight the original documents.

This symbol is used throughout the forms to indicate when documentary evidence must be provided. Please attach all documentary evidence at the back of the form.

HOW TO HAVE A DOCUMENT CERTIFIED

Make a photocopy of the original document and take the original and the copy to a person authorised to witness a statutory declaration listed on page 6 of the information booklet.

The person must make the following statement on every page, either in writing or using a stamp:

“I have sighted the original document and certify this to be a true copy of the original.”

The person should then sign each statement and provide their designation, e.g. Police Officer, Public Notary.

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5 COMPLETING YOUR APPLICATION continued

PERSONS AUTHORISED TO WITNESS STATUTORY DECLARATIONS UNDER THE EVIDENCE (MISC. PROVISIONS) ACT 1958 (VIC) – SECTION 107A

a justice of the peace or a bail justicea public notaryan Australian lawyer (within the meaning of the Legal Profession Act 2004)a clerk to an Australian lawyerthe prothonotary or a deputy prothonotary of the Supreme Courtthe registrar or a deputy registrar of the County Courtthe principal registrar of the Magistrates’ Court or a registrar of deputy registrar of the Magistrates’ Courtthe registrar of probates or an assistant registrar of probatesthe associate to a judge of the Supreme Court or of the County Courtthe associate of an Associate Judge of the Supreme Court or of an associate judge of the County Courta person registered as a patent attorney under Chapter 20 of the Patents Act 1990 of the Commonwealtha member of the police forcethe sheriff or a deputy sheriffa member or former member of either House of the Parliament of Victoriaa member or former member of either House of the Parliament of the Commonwealtha councillor of a municipality

a senior officer of a Council as defined in the Local Government Act 1989; a registered medical practitioner registered under the Health Practitioner Regulation National Law (Victoria) Act 2009 a registered dental practitioner registered under the Health Practitioner Regulation National Law (Victoria) Act 2009 a veterinary practitionera pharmacist registered under the Health Practitioner Regulation National Law (Victoria) Act 2009a principal within the meaning of the Education and Training Reform Act 2006the manager of an authorised deposit-taking institutiona member of the Institute of Chartered Accountants in Australia or the Australian Society of Accountants or the National Institute of Accountantsthe secretary of a building societya minister of religion authorised to celebrate marriagesa person employed under Part 3 of the Public Administration Act 2004 with a classification that is prescribed as a classification to which this section applies or who holds office in a statutory authority with such a classificationa fellow of the Institute of Legal Executives (Victoria)

Applicants who complete this form while interstate or overseas must have their documents certified by a person authorised to do so in that State, Territory or country, e.g. a Public Notary.

The Institute will neither return the certified copies of documents submitted with your application nor provide copies of these documents to you in future.

6 PRIVACY STATEMENT

The Institute is committed to protecting your privacy, and the confidentiality and security of the personal information you provide. The personal information you provide on this notification form is required by the Act.

The personal information provided by you will be used to:

assess your eligibility for registration;

maintain the public Register of Teachers; and

give effect to the statutory functions and administration of the Institute.

If you do not provide us with this personal information, we may not be able to process your application.

The personal details you have provided may be disclosed only where necessary for the Institute to perform its functions. Persons and organisations that may be provided with information include:

Members of the Public who may inspect the Register of Teachers which discloses a teacher’s name; registration status, including the type of registration; qualifications; date of registration; and registration number;

Organisations contracted by the Institute to provide administrative support;

CrimTrac Agency and Australian Police Services to obtain a National Criminal History Record Check.

You have the right to request access to personal information held by the Institute. You also have the right to request that the Institute correct that information if it is incorrect. Requests for access to documents containing personal information and in the control of the Institute will be handled in accordance with the Freedom of Information Act 1982 or Principle 6 of the Information and Privacy Act 2000 (Vic). Please contact the Institute with any such requests.

7 DECLARATIONS REGARDING DISCIPLINARY ACTION

You are required to truthfully complete Section 6 on the form, declaring any disciplinary proceedings; cancellation or suspension of eligibility for employment as a teacher or conditions in practising the profession.

8 STATUTORY DECLARATION AND AUTHORISATION

Section 7 must be completed and signed before a person authorised to take Statutory Declarations. Please refer to page 6 of this booklet for a list of authorised persons.

In signing this section of the application form, you authorise the Institute to conduct a police record check, if registration is granted, from time to time during the period for which the registration remains in force.

A person making a false declaration and signing this Statutory Declaration may be committing perjury.

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9 PROOF OF IDENTITY AND CONSENT TO ObTAIN A NATIONAL CRIMINAL HISTORY RECORD CHECk

The Institute requires all registered teachers in Victoria to undergo a National Criminal History Record Check (NCHRC). This check covers all Australian States and Territories. The Institute will obtain an NCHRC for you through the CrimTrac Agency. If you do not consent to the Institute obtaining an NCHRC the Institute will obtain a criminal record check without your consent. Section 2.6.22(2) of the Act allows the Chief Executive Officer of the Institute to obtain information about a teacher’s criminal record without the consent of the teacher. The Institute would prefer to obtain an NCHRC with a teacher’s consent and you are therefore encouraged to complete this consent form. The cost of your NCHRC is included in your application fee.

Employers require evidence that an NCHRC has been conducted as a condition of employment. Employing schools in Victoria accept an NCHRC conducted by the Institute as evidence that a satisfactory criminal record check has been carried out. Once the Institute has undertaken an NCHRC on your behalf and the outcome is satisfactory, your registration card will include the letters ‘NCHRC’ and the date the check was completed.

INDICTABLE OFFENCES

An indictable offence is an offence that carries a maximum term of imprisonment of five years or more, or where a fine of $60,000 or more can be imposed. Offences under the Crimes Act 1958 (Vic) and the Wrongs Act 1958 (Vic) are indictable offences unless categorised as summary offences. Examples of indictable offences are – culpable driving, theft, intentionally causing serious injury, stalking and assault.

If your NCHRC shows that you have been convicted or found guilty of an indictable offence, the Institute must conduct an inquiry into your suitability to teach. Indictable offences are assessed against the Institute’s Criminal Record Check Policy which is available on the Institute’s website. Please note the Institute will not cancel your registration automatically because you have been convicted or found guilty of an indictable offence, other than a sexual offence as defined in Section 1.1.3 of the Education and Training Reform Act (the Act).

SEXUAL OFFENCES

A sexual offence is defined in Section 1.1.3 of the Education and Training Reform Act (the Act) as:

certain nominated offences under the Crimes Act 1958 (Vic) against minors (under 18 years);

attempting to commit any of the above offences; AND

any offence committed in Victoria or elsewhere where elements of that offence consist of, or include, elements of the offence referred to above.

If your NCHRC shows that you have been convicted or found guilty of a sexual offence in Victoria or elsewhere, the Institute must cancel your registration without holding a hearing.

A registered teacher must notify the Institute within 30 days if committed for trial or convicted or found guilty of a sexual or other indictable offence.

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SPENT CONVICTIONS

A “spent conviction” is a conviction for a Commonwealth, or Victorian that all of the following conditions:

it is 10 years since that date of the conviction (or 5 years for juvenile AND

the individual was not sentenced to imprisonment or was not sentenced to imprisonment for more than 30 months; AND

the individual has not during the 10 years (5 years for juvenile AND

a statutory or prescribed exclusion (list available from the Privacy Commissioner) does not apply.

Similar provisions apply in other Australian States and Territories.

Commonwealth

Part VIIC of the Crimes Act 1914 (Cth) deals with aspects of the collection, use and disclosure of old conviction information and sets up a “Spent Convictions Scheme”. The aim of the Scheme is to prevent discrimination on the basis of old minor convictions once a waiting period has passed and provided the individual has not during this period. The law also covers situations where an individual has had a conviction “quashed” or has been “pardoned”. A quashed conviction is a conviction that has been set aside by the Court. A pardon means a free and absolute pardon that has been granted to a person because he/she was wrongly convicted of a Commonwealth, Territory, State or foreign o .

Victoria

Teachers have been excluded from the Spent Convictions Scheme operating in Victoria.

This means that all convictions and of guilt will be disclosed.

10 LODGING YOUR APPLICATION

You may lodge your application personally between 8.30am and 5.00pm at:

Level 9 628 Bourke Street Melbourne 3000

By MailThe Victorian Institute of Teaching PO Box 531 Collins Street West Victoria 8007

EnquiriesTelephone: 1300 888 067 Email: vit@vit.vic.edu.au

Please do not submit your application by fax

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PROOF OF IDENTITY AND CONSENT TO OBTAIN A NATIONAL CRIMINAL HISTORY RECORD CHECK continued

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VIT 2011/MR/1

REGISTRA

TION

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1.0 PERSONAL DETAILS

1.1 APPLICANT DETAILS

Title

Surname or family name

First given name

Other given name

Day Month Year

Date of birth / /

Sex M-Male F-Female

Are you an Australian citizen Yes No

If no, of what country are you currently a citizen?

1.2 POSTAL ADDRESS

Postal address

Suburb/Town

Country Postcode

Important: Please advise the Institute of any changes in postal address.

1.3 CONTACT NuMbERS

Please provide at least one contact number or email.

After Hours Phone

Business Phone Business Fax

Mobile Email

2.0 EVIDENCE OF CuRRENT REGISTRATION

This application for registration under Mutual Recognition applies only to persons who hold current teacher registration in Queensland, South Australia, Tasmania, Western Australia, the Northern Territory or New Zealand.

Do you hold current teacher registration in any of the above jurisdictions? Yes No

If yes, which jurisdiction?

Attach a certified copy of your current certificate of registration or registration card to seek registration with the Victorian Institute of Teaching in accordance with the Mutual Recognition Principle.

mUTUAL ReCOGNITION APPLICATIONPlease read the entire form and follow the advice in the information guide when completing this application form.

Date

OFFICE uSE ONLY

OFFICE uSE ONLY

MR DIVISION

MR AUTHORITY

Meeting Date

NCHRC

Quals Entered

Payment

Officer

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3.0 TEACHING QuALIFICATION/S

3.1 Have you completed an initial teacher education qualification? Yes No (e.g. Bachelor of Education, Graduate Diploma of Education)

Please provide details of all teaching qualifications completed in the following table.

NAME OF QuALIFICATION NAME OF INSTITuTION STATE OR COuNTRY FuLL TIME DuRATION OF PROGRAM

DATE COMPLETED

Attach certified copies of the qualification/s, which should include an official academic record (transcript), official evidence of completion, and transcripts for units completed elsewhere that counted towards this qualification/s. If you are unable to provide transcripts at this stage, you will be required to submit them at a later date.

4.0 ACADEMIC AND/OR TRADE QuALIFICATIONS

4.1 ACADEMIC AND/OR TRADE QuALIFICATIONS

Have you completed any other academic and/or trade qualifications?(This refers to any post-year 12 studies completed at a higher/further education institution, e.g. Bachelor of Arts, Diploma of Music Performance, Certificate of Proficiency (Joinery), Certificate IV in Information Technology) Yes No

If no, go to Section 5.

Please provide details of all qualifications completed in the following table.

NAME OF QuALIFICATION NAME OF INSTITuTION STATE OR COuNTRY FuLL TIME DuRATION OF PROGRAM

DATE COMPLETED

Attach certified copies of the qualification/s, which should include an official academic record (transcript), official evidence of completion, and transcripts for subjects studied elsewhere that counted towards this qualification/s. If you are unable to provide transcripts at this stage, you will be required to submit them at a later date.

4.2 INDuSTRIAL/TRADE EXPERIENCE

Do you have trade or industrial experience? Yes No

If yes, which trade?

I have attached evidence of my trade/industrial experience. Yes No

Number of years of experience?

Attach certified evidence of industrial or trade experience (e.g. official references or statement from your accountant, if self-employed). If you are unable to provide this evidence at this stage, you will be required to provide it at a later date.

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RECORD OF TEACHING EXPERIENCE (WHERE APPLICAbLE)

Do not include supervised teaching practice or any period of paid or unpaid leave from employment.

POSITION SCHOOL OR INSTITuTIONSTATE ORCOuNTRY

FuLL TIME OR FRACTION PER WEEK

DATE FROMMONTH/YEAR

DATE TOMONTH/YEAR

6.0 DECLARATIONS REGARDING DISCIPLINARY ACTION

If any registration authority has, on disciplinary grounds or in anticipation of criminal, civil or disciplinary proceedings:

(a) cancelled your registration as a teacher;(b) suspended your registration as a teacher; or(c) placed a condition on your registration as a teacher,

the Institute may also cancel or suspend your registration or impose the same condition on your registration.

You are asked to answer the following questions so that the Institute can establish whether action has been taken against you by any teacher registration authority.

Please note the Institute is authorised to request any registration authority to supply this information.

6.1 Have you ever been subject to disciplinary proceedings in any Australian State or Territory Yes No or in New Zealand (including any preliminary investigations or action that might lead to

disciplinary proceedings) in relation to your occupation as a teacher?

6.2 Has your registration in any Australian State or Territory or in New Zealand been cancelled Yes No or suspended as a result of disciplinary action?

6.3 Have you ever been personally prohibited from carrying on the occupation of teaching Yes No in any Australian State or Territory or in New Zealand?

6.4 Is your occupation as a teacher subject to any special condition as a result of criminal, civil Yes No or disciplinary proceedings in any Australian State or Territory or in New Zealand?

If yes, please specify any condition to which you are subject when carrying out your occupation as a teacher.

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7.0 STATuTORY DECLARATION AND AuTHORISATION

I Applicant’s full name Applicant’s occupation

of Applicant’s address

do solemnly and sincerely declare that:

I am seeking registration as a teacher with the Victorian Institute of Teaching in accordance with the Mutual Recognition Principle.

I am currently registered as a teacher in

(If more than one, name all jurisdictions in which you have current teacher registration)

My registration number is / numbers are

I am not the subject of disciplinary proceedings in any Australian State or Territory or in New Zealand (including any preliminary investigations or actions that might lead to disciplinary proceedings in relation to my registration as a teacher).

My registration as a teacher in any Australian State or Territory or in New Zealand has not been cancelled or is not currently suspended as a result of disciplinary action.

I have not been personally prohibited from carrying on my occupation as a teacher in any Australian State or Territory or in New Zealand as a result of criminal, civil or disciplinary proceedings in any Australian State or Territory or in New Zealand.

My registration as a teacher is not subject to any special conditions as a result of criminal, civil or disciplinary proceedings in any Australian State or Territory or in New Zealand.

I consent to the Victorian Institute of Teaching making inquiries of, and exchanging information with any registration authority in any Australian State or Territory or in New Zealand regarding my activities as a teacher or other matters relevant to this notice.

I certify that the copy of my current registration certificate(s) is a complete and accurate copy of the original. I understand that under the terms and conditions of the Education and Training Reform Act 2006, my name,

registration status, including the type of registration; qualifications; date of registration and registration number will appear on the public Register of Teachers.

I have completed this ‘Notification to the Victorian Institute of Teaching’ and I acknowledge that the information provided in this application form is true and correct; and I have provided this declaration with the understanding and belief that a person making false declaration is liable to the penalties of perjury.

I authorise the Institute, if registration is granted, to conduct a police record check from time to time during the period for which registration remains in force.

Declared at ______________________________________ ________________________________________________ Place in the State of Victoria

this ________ day of _____________ , ________________ signed ____________________________________ Day of month Month Year Signature of person making this declaration, to be signed in front of an authorised witness*

before me __________________________________________________________________________________________

Signature of authorised witness

____________________________________________________________________________________________________ Name and title of authorised witness, e.g. Police Officer

____________________________________________________________________________________________________ Address of authorised witness

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DECLARATIONS REQuIRED bY THE education and training reform act 2006

Are you currently charged with any indictable offences in any Australian State or Territory Yes No or in any other country?

If yes, please give further details:

Have you ever been convicted or found guilty of an indictable offence in any Yes No Australian State or Territory or in any other country?

If yes, please give further details:

9.0 PROOF OF IDENTITY AND CONSENT TO ObTAIN A NATIONAL CRIMINAL HISTORY RECORD CHECK

9.1 PERSONAL DETAILS

The details provided in Section 1 of this form will be used as your personal identification details. Please ensure all details are correct.

PLACE OF bIRTH

Place or town of birth Country of birth

PROOF OF IDENTITY DOCuMENTS

The Institute must verify your identity for registration and before an NCHRC is undertaken on your behalf and your name is added to the Register of Teachers. Your identity can be verified by providing documentary evidence that satisfies ‘100 Point Check’ (201) as required pursuant to the Financial Transaction Reports Act 1988.

What documents will be provided as proof of your identity? Select one from each category and provide additional details where requested.

Category 1 – Primary identification document showing your full name and place and date of birth.

Certified copy of your Birth Certificate

Certified copy of your Australian Citizenship Certificate

Certified copy of a current passport in your name

Passport number Expiry date / / Country/State of issue

Category 2 – Secondary identification document confirming your photograph or signature, date of birth, name and/or address.

Certified copy of your driver’s licence

Licence number Expiry date / / Country/State of issue

Certified copy of your identity card when employed under Part 3 of the Public Administration Act 2004 (Vic)

Certified copy of your Centrelink card

Certified copy of your student card issued by a higher education provider

A reference by a registered teacher verifying your name and address

You must attach certified photocopies of your Category 1 and Category 2 identity documents.

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9.0 proof of identity and consent to oBtain a national criminal history record check continued

9.2 chanGe of name

Is your current name different from the name on your Birth Certificate? Yes No

Have you ever been known by a name other than the name on your Birth Certificate? Yes No

List all other names by which you have been known in the table below.

sUrname / family name first GiVen name reason

sUrname / family name first GiVen name reason

you must attach certified photocopies of evidence of all name changes (e.g. marriage certificate, decree nisi, deed poll). if you cannot obtain these documents please submit a statutory declaration explaining your name change.

9.3 residential address history

Is your current residential address the same as your postal address? Yes No

If no, please provide your current residential address.

Residential address

Suburb/Town Country Postcode

Have you lived at any different address(es) in the past 5 years? Yes No

if full details of previous addresses are unavailable, details of town(s) and state(s) will suffice. attach list if insufficient room.

if actual dates are unavailable, details of year of residence will suffice.

residential address(es) period of residence

sUrname / family name / / to / /

sUrname / family name / / to / /

sUrname / family name / / to / /

9.4 consent for a national criminal history record check

Section 2.6.8(b) of the Education and Training Reform Act 2006 (the Act) requires the Institute to determine whether an applicant is suitable to be registered as a teacher.

The Institute conducts criminal record checks, called National Criminal History Record Checks (NCHRCs) through CrimTrac, a Commonwealth Agency.

An NCHRC is a report made following an examination of the records of convictions/findings of guilt of criminal offences held by Australian police services. The local police service will examine its records to determine whether a person with your name and date of birth has been convicted or found guilty of an offence.

Occasionally the Institute may receive criminal history information for a person with a similar name and/or date of birth to you. The Institute will write to you and ask you to verify that the information relates to you. If the information does not relate to you, it will be destroyed and CrimTrac will be advised of the error.

It is usual practice for an applicant’s personal information to be disclosed to Australian police services for them to use for their respective law enforcement purposes including the investigation of any outstanding criminal offences.

If you do not consent to the Institute obtaining an NCHRC, the Institute will not be able to process your application for registration under the Mutual Recognition Principle.

Information received through these processes will be stored in secure personal files. This form will remain on your personal file at the Institute. The information obtained by the Institute is subject to the Information Privacy Principles set out in the Information Privacy Act 2000 (see page 7 of the information booklet).

all applicants should complete the form on the next page and ensure it is submitted with this application.

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N9.0 PROOF OF IDENTITY AND CONSENT TO ObTAIN A NATIONAL CRIMINAL HISTORY RECORD CHECK continued

I ________________________________________________________________________________________________________________________ Applicant’s name

1 consent to:

the Victorian Institute of Teaching (the Institute) disclosing personal information provided by me in this form to CrimTrac and/or to Australian police services;

the Australian police services disclosing from their records details of convictions and outstanding charges, including findings of guilt or the acceptance of a plea of guilty by a court, that can be disclosed in accordance with the laws of the Commonwealth, States and Territories and, in the absence of any laws governing the disclosure of this information, disclosing in accordance with the policies of the police service concerned;

CrimTrac providing the information disclosed by the Australian police services to the Institute in accordance with the laws of the Commonwealth;

2 acknowledge that:

I have read the information attached to this form and understand that teachers have been excluded from the Spent Convictions Scheme operating in Victoria;

Any information provided by the Australian police services as a result of the National Criminal History Record Check may result in an inquiry being conducted by the Institute into my suitability to teach or my registration being automatically cancelled;

If I am employed as a teacher by the Department of Education and Early Childhood Development, the Institute may provide to the Department any criminal history information contained in my National Criminal History Check;

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.

Signature Date _____________________________

for further information, please refer to pages 8–9 of the information booklet.

Vi ctorian Institute of TeachingLevel 9, 628 Bourke StreetMelbourne 3000Telephone 1300 888 067Facsimile 8601 6101

August 2014