Current Employer: Have you previously YES NO NOT KNOWN undergone an integrity check If provide details ‘YES’, by WA Police? If a former WA Police employee / contractor, provide PD Number: Full Address (e.g.: 11 Smith Street, Perth WA 6000) Date From Date To List all residential addresses (in full) for the past 5 years, CURRENT DATE including all permanent and temporary addresses within Australia and overseas: Ensure there are no gaps in date history. Post office box addresses will not be accepted. SECTION 3 - INTEGRITY DECLARATION Have you been charged and / or YES NO ever convicted of any civil, criminal or traffic If provide full ‘YES’, offences, either in Australia or details overseas? Note: You are not required to provide details of any Spent Convictions in this application under the Spent Convictions Act 1988 (WA). Do you currently have any court YES NO matters pending against you, either in If provide full ‘YES’, Australia or overseas? details Have you ever received or been YES NO issued with a Restraining Order, If provide full ‘YES’, Domestic Violence Order, Police details Order or Interim Order or equivalent (as the ‘restrained’ person)? Have you ever been investigated by YES NO any Police, Defence Force, If provide full ‘YES’, Government Department (Federal, details State, Local), or other agency either in Australia or overseas? Have you ever had or have any family YES NO members, relatives, friends and / or If provide full ‘YES’, associates who have been charged, names and details of charges, convictions convicted or are involved in any and criminal activity, if criminal activity that you are aware of, known either in Australia or overseas?
Current Employer: Have you previously undergone an integrity check by WA Police? YES NO NOT KNOWN If ‘YES’, provide details If a former WA Police employee / contractor, provide PD Number: List all residential addresses (in full) for the past 5 years, including all permanent and temporary addresses within Australia and overseas: Ensure there are no gaps in date history. Post office box addresses will not be accepted. Full Address (e.g.: 11 Smith Street, Perth WA 6000) Date From Date To CURRENT DATE SECTION 3 - INTEGRITY DECLARATION Have you ever been charged and / or convicted of any civil, criminal or traffic offences, either in Australia or overseas? Note: You are not required to provide details of any Spent Convictions in this application under the Spent Convictions Act 1988 (WA). YES NO If ‘YES’, provide full details Do you currently have any court matters pending against you, either in Australia or overseas? YES NO If ‘YES’, provide full details Have you ever received or been issued with a Restraining Order, Domestic Violence Order, Police Order or Interim Order or equivalent (as the ‘restrained’ person)? YES NO If ‘YES’, provide full details Have you ever been investigated by any Police, Defence Force, Government Department (Federal, State, Local), or other agency either in Australia or overseas? YES NO If ‘YES’, provide full details Have you ever had or have any family members, relatives, friends and / or associates who have been charged, convicted or are involved in any criminal activity that you are aware of, either in Australia or overseas? YES NO If ‘YES’, provide full names and details of charges, convictions and criminal activity, if known
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