BL - Police Vetting Form

POLICE VETTING SERVICE

REQUEST & CONSENT FORM
If you are accessing this form using the email you received following your Staff Info form submission, some information will already have been pre-filled using the details you provided. Please review the information already present in this form and ensure it is correct and up to date.

if you are accessing this form directly from the HR Portal, please make sure to fill out all required fields.

Thanks!

Blue Light HR
- Name *
  
  First NameLast Name
- List any middle names
- YesNo
- Role being vetted for*
- Previous Name/s
  
  First NameMiddle NameLast Name
- Previous Name/s
  
  First NameMiddle NameLast Name
- Previous Name/s
  
  First NameMiddle NameLast Name
- Yes, this is a renewalNo, this is my first Police Vet
- Date of birth*
  
  DayMonthYear
  Date
- Gender*
- Place of birth *
- Country of birth*
- Driver Licence number
- Residential Address*
  
  Street Address
  
  Suburb
  
  CitySuburb
  
  Postal / Zip Code
- To complete your Police Vetting form, you will need to submit two (2) forms of ID.
- Primary ID (Drivers Licence)*
  
  MUST BE FRONT AND BACK, INCLUDING THE EXPIRY DATE ON THE REVERSE OF YOUR ID
  Cancelof
- Secondary ID (Passport or Birth Certificate)*
  
  Cancelof
- 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:
  
  a. Conviction histories and infringement/demerit reports.
  
  b. Active investigations, charges and warrants to arrest.
  
  c. Charges that did not result in a conviction including those that were acquitted (not guilty), discharged without conviction or withdrawn.
  
  d.Any interaction I have had with New Zealand Police relevant to the role being vetted, including investigations that did not result in prosecution or were resolved by an alternative resolution programme.
  
  e. Information regarding family violence where I was the victim, offender or witness to an incident or offence. This is particularly relevant where the role being vetted for takes place in a home environment where exposure to physical or verbal violence could place vulnerable persons at emotional or physical risk.
  
  f. Information subject to name suppression where that information is necessary for 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 for the purpose of an overseas visa/work permit and authorises the vetting report to be provided directly to the relevant embassy, high commission, or consulate.
  
  Please see the vetting website for more information regarding the Clean Slate legislation and what may be released.
  
  3. The Police Vetting Service may disclose newly obtained relevant information to the requesting agency after the completion of the Police vet in the following circumstances:
  
  a. The disclosure of the newly obtained information is justified under the Privacy Act 2020 (if it had existed or been available at the time of the Police vet, it would have been disclosed); and
  
  b. The Police Vetting Service has taken steps to confirm that the purpose for the Police vet still exists - e.g., that I am employed or engaged in a role that required a Police vet. The Police Vetting Service will take reasonable steps 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 report released to the agency (to be provided by the agency) and can request a correction of any personal information by contacting the Police Vetting Service.
  
  6. Please notify the agency or the Police Vetting Service if you wish to withdraw your consent.
  
  For further information about the vetting process, please see the vetting website.
- HR Blue Light (Email)
- HR Blue Light (Name)
- - 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 relevant to my application (as described above) to the agency making this request for the purpose of assessing my suitability.
  - I have read and understood the information and provide consent as specified above
- Signature*
  
  Clear
- Date*
  
  DayMonthYear
  Date
- Should be Empty:

POLICE VETTING SERVICE