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Vetting Service Request and Consent Form

The following form needs to be completed by all Coaches and Assistant Coaches at Tawa Junior Football Club that are new to the club or are due for repeat vetting (every 2 years).

Please read carefully and complete all of the sections below, including the Consent to Release Information section.

PERSONAL INFORMATION:
(note: the name you are most commonly known by is your primary name)

Gender:

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.

Permanent Residential Address:

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:

    ​- Conviction histories and infringement/demerit reports
    - Active charges and warrants to arrest
    - Charges that did not result in conviction including those that were acquitted, discharged without conviction, diverted or withdrawn
    Any interaction I have had with New Zealand Police considered relevant to the role being vetted, including investigations that did not result in prosecution
    - Information regarding family violence where I was the victim, offender or witness to an incident or offence, primarily in cases where the role being vetted takes place in a home environment where exposure to physical or verbal violence could place vulnerable persons at emotional or physical risk
    - Information subject to name suppression where that information is necessary to 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 Vulnerable Children Act 2014 applies to this request (safety checks of core children's workers).

    c. The vetting request is made by an individual for the purpose of an overseas Visa/Work Permit as a Privacy Act request authorising the vetting result to be provided directly to the relevant embassy, high commission or consulate.
    Please see the guide for more information regarding the Clean Slate legislation.

  3. The Police Vetting Service may disclose newly-obtained relevant information to the Approved Agency after the completion of the Police Vet in the following circumstances:
    - The disclosure of the newly-obtained information is considered to be justified under the Privacy Act 1993 (if it had existed or been available at the time of the Police vet, it would have been disclosed); and
    - The Police Vetting Service has taken steps to confirm that the purpose of the Police vet still exists - e.g. that I got the role which required a Police vet and am still employed or engaged in it.
    The Vetting Service will endeavour 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 result released to the Approved Agency (to be provided by the agency) and can seek a correction by contacting the Vetting Service.

  6. The Approved Agency will securely dispose of this consent form, copies of identification documents and the vetting result within 12 months of receiving the result unless a longer retention period is required by legislation.

  7. I may withdraw this consent, prior to Police's disclosure of the vetting result, by notifying the Approved Agency.
     

For further information, please see the Guide to Completing the Consent Form.

APPLICANT'S AUTHORISATION:

Please read the ID requirements below then submit:

 

​Two forms of ID must be sighted - one primary and one secondary, one of which must be photographic.​

 

Primary IDs include:

  • Passport (NZ or Overseas)

  • NZ Firearms Licence

  • NZ Full Birth Certificate (issued on or after 1998

  • NZ Citizenship Certificate

  • NZ Refugee Travel Document

  • NZ Emergency Travel Document

  • NZ Certificate of Identity
     

Secondary IDs include:

  • NZ Driver Licence18+ card

  • NZ Full Birth Certificate (issued before 1998)

  • Community Services card

  • SuperGold Card

  • NZ Employee Photo Identification Card

  • NZ Student Photo Identification Card

  • Inland Revenue number

  • NZ issued utility bill (issued not more than six months earlier)

  • NZ Teachers Registration certificate

  • NZ Electoral Roll Record

  • International Driving Permit

  • Steps to Freedom Form

 

Current identity documents are preferred, but documents that have expired within the past five years may be accepted.

These documents must be shown to Nicola, our Police Vetting Officer, at the Coaches Evening (Wednesday 5th April). If you are unable to attend, please email policevetting@tawafootball.org.nz to arrange to meet Nicola another time.

Thanks for supporting Tawa Junior Football.

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