eCPC

	Non-Teaching Tertiary Practicum Student Application Form Student teachers participating in professional experience in a NSW public school, should complete the Pre-service Teacher Registration Form
	27-Jul-2024 18:14

Declaration for Child Related Work - Non-Teaching Tertiary Practicum Students

This declaration must be completed by students undertaking unpaid tertiary practicum placement with the Department of Education (the Department) where the person is required to hold a NSW Working with Children Check clearance under the Child Protection (Working with Children) Regulation 2013. See the Department's Working with Children Check Procedure for more details.

Name Details

Name on NSW WWCC clearance

Name Type

Title

First Name

Middle Name

Family Name

Are/were you known under a different name?*

Yes

No

Please select the name that was used on your NSW WWCC Clearance from the above

Street address:*

Street address (2):

Suburb:*

State:

Post Code:

Personal Email:*

Telephone:

Mobile:

Date of birth:*

Gender :*

Suburb/Town/City of birth:*

State of birth(if AUS):

Country of birth:*

Country of citizenship:*

NSW WWCC number from OCG (e.g. WWC1234567V):*

Departmental ID number (if known):

NSW Department of Education placement details (if known)

School

Anticipated start date of practicum placement:*

I give approval for my contact details to be included on relevant Department mailing lists. *

Yes

No

Identity document: Upload Government-issued photo identity document with full name, date of birth and current residential address and, if relevant, change of name document. The Department may verify any document with the issuing authority. Click here for guide to Identity Documents

Note:

A digital driver's licence's is not acceptable for Working With Children Check verification purposes. Digital IDs are only acceptable for club entries or if you are presenting yourself in person for identity verification.
Uploading documents is a two-step process 1. Click on the 'Choose' button to select your document from a directory 2. Click on 'Upload' to attach the chosen document to your application.
You will be required to provide more than one identity document if you don't have a single document that contains all the required information stated above.
The maximum size of any document to be uploaded cannot exceed 20mb.
Accepted file types - PNG, PDF, JPG, DOC and DOCX.

Choose/Upload proof of identity.

File Name
No records found.

Choose

Section A - I declare that:

I have no criminal convictions in the past ten years. I understand that "conviction" is defined in the Criminal Records Act 1991 and includes a conviction, whether summary or on indictment for an offence, and includes a finding or order that an offence has been proved, or that a person is guilty of an offence, without proceeding to conviction.
I am not subject to any pending court proceedings relating to a criminal matter in Australia or overseas.
I have no convictions that cannot become spent within the meaning of the Criminal Records Act 1991 including but not limited to:
1. convictions for which a prison sentence of more than six months has been imposed; or
2. convictions of sexual offences.

Section B – I am unable to make the relevant declaration in Section A.

Privacy Statement

All public schools and personnel of the Department of Education must abide by the Privacy and Personal Information Protection Act 1998 (NSW). The information you provide will be used to verify your Working with Children Check (WWCC) clearance and for associated purposes such as:

managing risk associated with the department's legal obligation to ensure the protection of children and young persons in its care;
creating your department identity and email address used for the purposes related to your professional experience placements with the department;
using your contact details to communicate with you to provide information about department scholarships, funded study and employment opportunities;
to ensure the health and safety of students, staff and visitors to the school;
state and federal reporting purposes;
for any other purpose required by law.

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