Swimming NZ Police Vetting Application + Consent to Disclose Form

Police Vetting Application + Consent & Disclose Form

Swimming NZ
Application Information
Family Name (Primary)*
First/Middle Name(s)*
Gender*
Date of Birth*
DD/MM/YYYY
Place of Birth*
Town/City/State
Country of Birth*
Town/City/State
NZ Drivers Licence Number
If Applicable
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. Please include ALL names (first, middle and last) for each alias/previous name
Address*

Flat/Number

Street

SuburbTown/City

Postal / Zip Code
Click here to view the Police Vetting website for further information
Authorisation of person being vetted:*

I confirm that the information I have provided in this form relates to me and is correctI have read and understood the information aboveI authorise New Zealand Police to disclose any personal information relevant to my application (as described above) to the agency making this request for the purpose of assessing my suitability
Proof of Identification - Primary

eg: Passport - please note you can opt to email to policevetting@swimming.org.nz as the alternative option for submitting both forms of ID
Cancelof
Proof of Identification - Secondary

eg: NZ Drivers Licence - please note you can opt to email to policevetting@swimming.org.nz as the alternative option for submitting both forms of ID
Cancelof
Digital Signature*

Clear
Date Signed & Completed*
Today's Date - DD/MM/YYYY

Police Vetting Application + Consent & Disclose Form