A police check application form is designed to help police officers carry out checks in your premises or properties. Below is an example of a police check application form.
PERSONAL DETAILS (APPLICANT DETAILS)
Full names: ____________________________
Birth date: _____________________________
Place of birth: __________________________
Tel No: _______________________________
Drivers license No: ______________________
Address:______________________________
Street No: _____________________________
Street Name: ___________________________
State: _________________________________
Country: _______________________________
MAILING ADDRESS FOR POLICE CERTIFICATE
Do you want the police certificate to be posted to the indicated address? YES ________
NO_________
(Mark the correct one with a tick)
If no please indicate the name and address you want it posted
Name:_______________________________
Name of the street:_____________________
Street No:____________________________
Address:_____________________________
Postal code:___________________________
State:________________________________
FINGERPRINTS
Fingerprint checks must be carried out for this form is completed. Please submit them together with this form.
Which department took your fingerprints? ________________________________________________
___________________________________________________________
DECLARATION
I declare that all the personal information I have given relates to me and is correct. I acknowledge that the information given in this form will not be used without my permission for any reasons, unless otherwise authorized by law.
Applicant’s signature:______________________
Date: ___________________________________________
If you are under 18 yrs of age you require a consent from your parents/guardians.
Signature of parent/Guardian:_________________________
Date:_____________________________________________
………………………………………………………………….
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