screening request

	Pre-service Teacher Registration Form
	02-Jul-2024 22:05

Declaration for Child Related Work

Pre-service teachers undertaking professional experience placements at NSW public schools are required to hold a valid Working with Children Check (WWCC) clearance under the Child Protection (Working with Children) Regulation. NSW Department of Education (department) is required to verify that your WWCC is valid prior to commencing your placement. Find out more here

The following information you provide must match the information on your WWCC clearance:

Last name

Date of Birth

WWCC number

First Name:*

Last Name:*

Former Last Name (if WWCC under former name)

Date of birth (dd/mm/yyyy): *

Gender :*

NSW WWCC number: *

Department employee ID

Enter if you are a current or past employee of the department

Contact Details

Email:*

Mobile Number:*

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.

I declare

I have (or would be able to apply and receive) a WWCC: I am not disqualified from obtaining a WWCC through being convicted or having a finding of guilt for a disqualifying offence, or had a WWCC cancelled, refused or been the subject of an interim bar (except where a WWCC has been later granted).
I have no pending criminal charges, court proceedings or allegations that would (if a conviction was upheld) be a disqualifying offence preventing a WWCC being issued. I am not subject to any pending court proceedings or the subject of allegations or charges relating to a criminal matter in Australia or overseas.
I have not supplied any false or misleading information: I am aware that providing false or misleading information in this form may lead to the department withdrawing any offer of engagement or contracting services and consider this for any future applications from myself or my organisation for employment or engagement.

I am able to make this declaration and agree to the department's privacy statement

I am unable to make this declaration

Please tell us about your teaching degree

Institution*

Degree*

Level*

Undergraduate

Postgraduate

Mode of study*

Full time

Part time

Location*

On Campus

Remote

Hybrid

Start Date (mm/yyyy)*

Estimated Completion Year*

Setting:*

Early Childhood

Primary

Secondary

Do you hold a scholarship with the department?

If not, would you like to find out more about a scholarship with the department?

The department offers a range of opportunities including:

scholarships and funded study opportunities
professional learning resources and events
employment opportunities during and after studies

Please keep me informed about opportunities at the department

If any issues arise when submitting this form, please follow the instructions on screen. For other queries, please contact pst.registration@det.nsw.edu.au

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