Australian Federal Police National Police Check (NPC) Application Form
1. Purpose of NPC
Office use only
Please complete this form by referring to the Application Completion Guide.
Enter the relevant code number from the table at Section 1: Purpose of NPC on the Application completion Guide (e.g. Fire fighting/prevention = Code No 15) If a code is not specified this application will be processed as a Standard Disclosure (Code 30). If the purpose is not listed or you are unsure please ring the AFP Criminal Records Help Desk on 02 6202 3333 for assistance.
Code Number:
2. Applicant Details If completing manually, use BLOCK LETTERS and black ink. Mark check boxes with a cross (X).
Current Family Name All Given Names Date of Birth
(DD/MM/YYYY)
Gender:
Male
Female
Previous or Other Names by which you are known or have been formerly known must be listed below (eg. maiden, deed poll). If more room is required, list on separate sheet, sign and send with this application form. Additional information sheet included Family Name:
(include all name changes and maiden name)
Given Names
Date of Birth
Place of Birth Country
Town
State
Telephone Numbers: Home Australian Drivers Licence Number
Work
Mobile Issuing State:
Copy Attached
Current Residential Address – Complete in FULL Unit No. Street No. Street Name / Street Type
Suburb/City
Post Code
State
Country
Date you started living at this address
Previous Residential Address – Complete in FULL Unit No. Street No. Street Name / Street Type
Suburb/City
Post Code
State
Country
Date you started living at this address
3. This is a private (ie non-account) application, do not complete this section.
Form
CR501
Version
1.05
Page 1 of 6
4. Mailing Address for Police Certificate
Is the Police Certificate to be posted to your current residential address? Yes No If NO: I authorise the Police Certificate to be forwarded to the...