12.07.2015 Views

Counselling Psychology Student Handbook.pdf - Health Sciences ...

Counselling Psychology Student Handbook.pdf - Health Sciences ...

Counselling Psychology Student Handbook.pdf - Health Sciences ...

SHOW MORE
SHOW LESS
  • No tags were found...

You also want an ePaper? Increase the reach of your titles

YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.

Criminal Record Screening InformationDUE TO SECURITY THIS FORM MUST BE POSTED IT WILL NOT BE ACCEPTED IN PERSONSTAFF-IN-CONFIDENCE (when completed)DEPARTMENT OF HEALTHCRIMINAL RECORD SCREENING CONSENT FORMUniversity Effective 1 st December 2005In accordance with the endorsed Criminal Record Screening Policy, this Consent Form isapplicable for those who require a Criminal Record Screening to work in, or provide servicesto, the Department of <strong>Health</strong> only. It should not be used for any other purposes.PLEASE COMPLETE IN BLOCK LETTERS.ALL QUESTIONS MUST BE ANSWERED AND THE CORRECT FEE ATTACHED BEFORE THEREQUEST WILL BE PROCESSED_______________________________________Family Name (Current)________________________________Given Names (Current)PLEASE ENSURE YOU SIGN THIS CONSENT FORMAGENCY DETAILSUNIVERSITY NAME:_______________________________________________________________________________FACULTY/COURSE:______________________________________________________________________________OTHER PERSONAL INFORMATION:______________________________________________________________________________MAIDEN NAME(S):______________________________________________________________________________ANY OTHER NAMES BY WHICH I AM, OR EVER HAVE BEEN, KNOWN (including changes by Deed Poll):______________________________________________________________________________Page 62 of 88Curtin University is a trademark of Curtin University of Technology.CRICOS Provider Code 00301J (WA), 02637B (NSW)

Hooray! Your file is uploaded and ready to be published.

Saved successfully!

Ooh no, something went wrong!