Get Qp Certificate

QUEENSLAND POLICE SERVICE APPLICATION FOR A POLICE CERTIFICATE NAME ONLY QP 0349C 07/07 A Police Certificate based on Australia-wide check of criminal history records using name only 47. Attached Forward completed forms IMMEDIATELY and DIRECTLY to Police Information Centre GPO BOX 1440 BRISBANE Qld 4001 QP 0349C Application for a Police Certificate Name Only Police station Any ENQUIRIES phone 07 3364 6705 Page 1 of 1. 65 Note Police Certificates are usually for EMPLOYMENT or VISA purposes Please print neatly using BLOCK LETTERS Proof of identity Please ensure a copy of ONE of the following forms of identification is attached to this application Your current driver licence Number Issuing state Your current passport including photograph and signature Issuing country OR Two other forms of identification bearing your signature. Documents produced Applicant details Family name Other names you have been known by Given name s such as name at birth alias es previous married name s / Date of birth Day Place of birth Postal address of applicant Private Male Female Year Town Telephone Month State Country Postcode Mobile Business E-mail Do you have a non-traffic conviction s recorded against you or a pending charge s in Australia Yes No If the Certificate is for visa purposes AND IF IT IS REQUIRED TO BE FORWARDED DIRECTLY to the Consulate of the country to which you are travelling state name and address of Consulate Employment Other please specify In consideration of the issue and supply of the document requested herein I hereby undertake and declare that I will not take any action either civil or criminal against the Commissioner of the Queensland Police Service or Police Service of any other State or Territory of the Commonwealth of Australia or of any other country or authorise or cause or procure or permit any person on my behalf to take any action concerning anything had or done by them in relation to this application. X Date Applicant signature Witness signature Witness name Privacy Statement The collection of this information is authorised by legislation or Queensland Police Service QPS policy established under the Police Service Administration Act 1990 Qld and the Police Powers and Responsibilities Act 2000 Qld. The information may be used to assist in performing the statutory functions and responsibilities of the QPS* The QPS may disclose some or all of this information to employees and contractors involved in the processing of this form* The information may also be disclosed to those persons and agencies outside the QPS as provided for by legislation or in accordance with the Information Privacy Act 2009. Failure to supply the requested information may mean that the QPS is unable to process this form* Police use only Copy of proof of identity must be attached to this form Fee paid Receipt no. 65 Note Police Certificates are usually for EMPLOYMENT or VISA purposes Please print neatly using BLOCK LETTERS Proof of identity Please ensure a copy of ONE of the following forms of identification is attached to this application Your current driver licence Number Issuing state Your current passport including photograph and signature Issuing country OR Two other forms of identification bearing your signature. Documents produced Applicant details Family name Other names you have been known by Given name s such as name at birth alias es previous married name s / Date of birth Day Place of birth Postal address of applicant Private Male Female Year Town Telephone Month State Country Postcode Mobile Business E-mail Do you have a non-traffic conviction s recorded against you or a pending charge s in Australia Yes No If the Certificate is for visa purposes AND IF IT IS REQUIRED TO BE FORWARDED DIRECTLY to the Consulate of the country to which you are travelling state name and address of Consulate Employment Other please specify In consideration of the issue and supply of the document requested herein I hereby undertake and declare that I will not take any action either civil or criminal against the Commissioner of the Queensland Police Service or Police Service of any other State or Territory of the Commonwealth of Australia or of any other country or authorise or cause or procure or permit any person on my behalf to take any action concerning anything had or done by them in relation to this application.