Ichc Philippines.pdf

International Criminal Record Check - Philippines Consent to Obtain Personal Information General Information This form is used by Equifax Australasia HR Solutions Pty Limited as part of the assessment process to determine whether a person is suitable for employment or other engagement for work with your current / potential employer. Unless statutory obligations require otherwise, the information provided on this form will not be used without your prior consent for any purpose other than in relation to the assessment of your suitability. You may be required to complete another consent form in the future in relation to employment in other positions within your current or potential employer.

Provision of False or Misleading Information You are asked to certify that the personal information that you have provided on this form is correct. If it is subsequently discovered for example as a result of a check of police records that you have provided false or misleading information, you may be assessed as unsuitable. You should note that the existence of a record does not mean that you will be assessed automatically as unsuitable. Each case will be assessed on its merit, so it is in your interest to provide full and frank details in the form

Instructions for Completing this Form Print and complete both pages of this form. Please complete all sections of the form that are relevant to you. Once completed, scan or photograph this form and one identification document, such as current passport, driver’s licence, student card, medical card or other form of ID. Email these images to [email protected]

Consent to Obtain Personal Information I

hereby:

1. Acknowledge that I have read the consent form and understand the purpose for which this consent is provided. 2. Have fully completed this form, and the personal information I have provided in it relates to me, contains my full name and all names previously used by me, and is correct. 3. Consent to Equifax Australasia HR Solutions Pty Limited disclosing personal information about me from this form to any partner organisations involved in completing the check.

International Criminal Record Check – Philippines Consent to Obtain Personal Information 4. Consent to Equifax Australasia HR Solutions Pty Limited disclosing to my current or potential employer personal information about me to assess my suitability in relation to my employment. 5. Acknowledge that any information provided by me on this form may be taken into account by my current or potential employer in assessing my suitability for the position for which I am applying.

I have read and understood the above. I agree to these conditions for the check to be conducted by Employment Verification and subsequent release of this information to the entity who ordered the check. I hereby release Employment Verification from any liability arising from a result of furnishing that information, save for any liability arising from an obligation to me that Employment Verification may have under either the Australian Privacy Act 1988 or the New Zealand Privacy Act 1993. Signed: Date:

Personal Details Surname

Given Names

Other known names / maiden name (also names known in Phillipines)

Date of Birth

Please list Philippines ID types and numbers below, starting with Passport details. This section is mandatory. Also indicate the type of document (passport, driver’s licence, medical card) followed by the number on that document. Document Type

Document Number Hong Kong ID

Document Type

Document Number

Document Type

Document Number

2

International Criminal Record Check – Philippines Consent to Obtain Personal Information Please list all of your residential addresses in the previous 10 years starting with your current address. If you need more space, please attach an additional page. This section is mandatory. Period of Residency Address 1

From Date

Address 2

Address 3

Address 4

Address 5

3

To Date