Do you like being involved in sport and exercise? Do you want to help people improve their physical wellbeing and sporting ability without committing to degree-level study? Then this diploma is for you.

The Diploma in Recreation and Sport will give you a foot in the door to the vibrant and people-oriented sport, health and fitness industries. You will learn how the human body is structured and how it functions so you can plan and organise exercise programmes for a wide range of people.

Campus EIT Hawke’s Bay

Starts February, July

Contact Sue Jackson Phone: 06 830 1521. Email: sjackson@eit.ac.nz

EASTERN INSTITUTE OF TECHNOLOGY

eit.ac.nz | 0800 22 55 348 |

2018For New Zealand Citizens & Permanent Residents

Diploma in Recreation and Sport

Do you like being involved in sport and exercise?The Diploma in Recreation and Sport is a one year full-time, or equivalent part-time, programme which offers you stimulating studies and provides a pathway to a career in the wide field of recreation, sport and leisure. This programme has close links with the Bachelor of Recreation and Sport.

In particular, the programme is designed to enable a student to:

▶ Understand human body structure and function with emphasis on the musculo-skeletal system

▶ Develop knowledge and skills related to professional practice in the recreation and sport industry

▶ Understand the relationship between nutrition, physical activity, and other personal health behaviours and health

▶ Develop knowledge of a range of sporting and recreational activities through practical experience and active participation

▶ Understand the sport and recreation industry in New Zealand ▶ Design and apply group exercise programmes ▶ Assess physical performance, apply exercise techniques and design

exercise for people with special needs

Subject areas covered are: anatomy and physiology, nutrition and health, and, leadership and coaching.

You are welcome to make an appointment to discuss your study options with our staff and to view our facilities.

YOUR FUTURE CAREER AND STUDY OPPORTUNITIESFor trained sport, fitness and recreation professionals, employment opportunities are varied and exciting.

Possible jobs and career opportunities can include:

▶ Personal trainer ▶ Community recreation assistant ▶ Community health initiatives assistant ▶ Group exercise instructor ▶ Sports coordinator

Further your study with the Bachelor of Recreation and Sport.

WHAT YOU NEED TO KNOWDiploma in Recreation and Sport

Level Level 5 Credits 125

Length One year full-time or equivalent part-time Fee $6,500 approximately

This is a guide only based on previous years. All costs quoted include GST and student services levy. Fees apply to New Zealand Citizens and New Zealand permanent residents only

PARTNERSHIPSWe value our partnership with students and aim to provide quality education in a supportive environment, encouraging personal growth and professional development.

KEY DATESINTAKE ONE

Programme starts Monday, 19 February

Semester ends Friday, 29 June

INTAKE TWO

Programme starts Monday, 23 July

Year ends Friday, 30 November

STATUTORY & EIT HOLIDAYS

Easter Friday 30 March - Tuesday 3 April Semester break Monday 2 - Friday 20 July

Semester One term break Monday 16 - Friday 27 April Semester Two

term break Monday 1 - Friday 12 October

Anzac Day Wednesday 25 April HB Anniversary Friday 19 October

Queen's Birthday Monday 4 June Labour Day Monday 22 October

TIMETABLEYour study time will be made up of contact time (class times, tutorials, industry-based learning) and non-contact time (your own individual study time, online learning).

CONTACT TIMEOn-campus classes are usually scheduled between 8.00 am and 5.00 pm Monday to Friday. Students enrolled in full-time study have approximately 20 hours on-campus per week.

NON-CONTACT TIMEStudents should plan to spend 16 hours of self directed study per week.

ADDITIONAL COSTS ▶ $500 for textbooks (approximately) ▶ $130 for EIT uniform – optional

(approximately)

Upon completion of degree and diploma studies, academic attire required for the graduation ceremony can be hired at the student’s expense.

ENTRY CRITERIA

ACADEMIC ENTRY CRITERIA ▶ Meet the NCEA Level 2 entry criteria with

60 credits at Level 2 in one year, OR ▶ Provide evidence of achievement at an

equivalent level.

HEALTH AND PROFESSIONAL CRITERIAAll applicants are required to:

▶ Sign a declaration and a request for personal information held on the Police computer.

▶ Sign a declaration that they are in good

health (having no medical, physical or psychological conditions that would preclude working with vulnerable clients).

If the declaration identifies any issue that may impact on the student’s ability to complete the programme, the student can discuss these with the programme coordinator at an information session. EIT reserves the right to decline entry to the programme should an applicant’s Police record or health difficulties be such that they would be considered unsuitable for the type of work undertaken whilst on this programme or by graduates of this programme. The guidelines on which this decision will be based are the relevant professional association or industry requirements.

ENGLISH LANGUAGE ENTRY REQUIREMENTApplicants for whom English is not their first language must have an acceptable level of English language fluency prior to enrolment in the programme. This may be demonstrated in a variety of ways, including successful study of a programme in which English was the language of instruction, completion of a New Zealand Certificate in English Language (Level 3), approved scores on IELTS tests (6.0 Academic with no band score lower than 5.5), completion of accepted international equivalents, or completion of an EIT assessment.

ENTRY WITH CREDITYou may already have some knowledge or skills that can be recognised as part of your intended study. This may take a number of different forms including study while at high school, study at a private training establishment, workplace training, other tertiary study, life experiences or voluntary work. If you think you may qualify, you may want to apply for Cross

Credit or Recognition of Prior Learning.

▶ Cross Credit is based on the equivalency of courses or qualifications. You would apply for Cross Credit if you have passed a very similar course at the same level.

▶ Recognition of Prior Learning (RPL) is based on the assessment of your current knowledge and skills. You would apply for RPL if you had gained the relevant knowledge and skills through life experiences and informal learning situations.

You will be asked to provide details of anything that you would like considered as credit toward your intended programme of study, as part of your application.

Recognition of Prior Learning and Cross Credit cannot be awarded for a course if you are enrolled in that course. Please contact your programme coordinator to discuss this option.

For further information and enquiries about RPL and Cross Credit please contact the School of Health and Sport Science Programme Secretary, Sue Jackson, telephone (06) 830 1521.

TRANSFERS/CROSS CREDITSA similar qualification may be delivered at a number of other tertiary institutes around New Zealand. If you were to transfer to one of those other institutes you may be granted academic credit for some of the papers completed successfully while studying at EIT, but this is at the discretion of the other institute.

Please note: Fees are not transferable between institutes.

FACILITIESPractical studies take place in the Pettigrew.Green Arena Hawke’s Bay. These facilities include a practical teaching space, an exercise science laboratory, a theatre for lectures and presentations for up to 80 people, changing rooms, consulting rooms, office and administration area, and a massage room.

ARENA GYMIncluded in the enrolment for the Diploma in Recreation and Sport is a user agreement to the gym facilities. Further details will be provided on acceptance into the programme.

ASSESSMENTSAssessments include essays, written reports, assignments, and written and practical examination.

DEGREE ELECTIVESStudents may select a relevant course from the EIT Elective Handbook. This must be approved by the programme coordinator prior to you enrolling in it.

THE EXPERIENCE YOU NEED & THE SUPPORT TO SUCCEEDWhen you study at EIT you’ll get the kind of experiences that will help you gain the knowledge and skills to get ahead.

You’ll also be supported by lecturers and tutors who are here for you, within a learning environment where you are treated as an individual, not just a number. They’ll know your name and you’ll receive one-on-one attention to make sure you get the support to succeed.

WORLD CLASS 'A' RATED TEACHING STAFFThe Tertiary Education Commission rates EIT as one of New Zealand’s top two institutes of technology and polytechnics for research. Our highly-qualified academics are leaders in their subjects, delivering the most up-to-date and relevant information to certificate, diploma, degree and postgraduate students. Attuned to ever-changing technologies, our tutors bring extensive work experience to teaching EIT’s certificate and other industry-tailored programmes.

Our lecturers are highly trained professionals with particular areas of expertise in recreation, sport and fitness. Staff also maintain contacts with other professionals through organisations such as PENZ (Phys-Ed New Zealand), Fitness N.Z., SFRITO (Sport, Fitness and Recreation Industry Training Organisation).

NAME QUALIFICATIONSheryl-Lee Judd Programme Coordinator Recreation and Sport

Dip. Health Sciences, ACAT, PGCertHSc

Lee-Anne Taylor Assistant Head of School / Lecturer Recreation and Sport

MHSc(Rehab), BPhty, BSc

Dr Carl Paton Senior Lecturer Recreation and Sport

Ph.D, MSC, BSC, PG Cert Ed.

Diana Kirton Practicum Manager

BA (Psyc)

Sue Scott-Chapman Senior Lecturer Recreation and Sport

BSpLS (Honors), PhD

NAME QUALIFICATIONGail Maxey Senior Lecturer Science

BSc, Dip.PE, Dip.Tchg

Edmond Otis Senior Lecturer Recreation and Sport

MS, MFT (Licensed Clinical Psychotherapist)

Dr Patrick Lander Senior Lecturer Recreation and Sport

PhD, MSc, BSc (Hons), CATA.

Maria Pearson Senior Lecturer Recreation and Sport

BPhEd, PGDipPE, MPhEd

Adam Blake Lecturer Recreation and Sport

BRS

COURSE DESCRIPTIONS

COMPULSORY

COURSE NO. BRIEF DESCRIPTION NO. OF

CREDITSNZQA LEVEL

SEMESTER OFFERED

BRS5.51 Te Aranga Ake: Recreation and Sport Landscapes

This course is designed to assist students to understand the breadth of the recreation and sport ‘landscape’, being a place of academic inquiry as well as applied professional work. It uses socio-cultural theory as a framework to examine contemporary issues in sport and recreation, exposing students to the multiple and sometimes contested perspectives that exist locally, nationally, and globally. The course commences with an exploration of culture through acknowledging and celebrating personal cultures before broadening its focus to an exploration of relevant and topical sporting and recreational issues. Course activities and assessments are designed to foster computer-based information literacy and academic writing skills to provide opportunities for students to develop academic competence. It aims to provide insights into study pathways and vocational opportunities in the sport and recreation sector.

15 5 1

AP4.11 Anatomy and Physiology

This course assists students to develop an understanding of human anatomy and physiology to provide a theoretical foundation for further study or employment in the health sciences and sport recreation. The organisation of the human body, basic chemistry, cells, tissues, the integumentary, skeletal, muscular, cardiovascular, energy and respiratory systems are examined in this course.

15 4 1

BRS5.45 Nutrition, Activity and Health

This course assists students to develop an understanding of the relationships between nutrition, physical activity, other lifestyle behaviours and health. Students will develop skills of critical thinking in relation to food, nutrition, health information, claims and beliefs. The course will explore meanings of health and wellness for students’ self-empowerment, health promotion, disease prevention and appreciation of human diversity.

15 5 1

BRS5.20 Leadership and Coaching

The course is designed to introduce students to theories and principles of leadership, coaching, communication, motivation and group dynamics in order for them to effectively lead groups of all abilities for planning and facilitating sport, recreation and leisure activities. It serves as a foundation course for further skill development in leadership, coaching and management, therapeutic recreation assessment, interpersonal helping and group facilitation.

15 5 2

530 Organisation and Management

The course begins with an introduction to management and organisations and then looks back at the development of management practices over the last two hundred years. Leadership skills, and the planning, organising and controlling functions in business, have undergone many changes due to research and practical application of innovative methods. The theories behind the changes, some of which are flawed, are also studied in the course. You will examine topical issues such as e-commerce, globalisation and the impact of the Treaty of Waitangi on all New Zealanders. The course is designed to make you think independently as well as learn new concepts and theories of management.

20 5 2

BRS5.21 Movement Education

This course is designed to provide students with an understanding of the principles of skill learning and movement education in terms of how they influence individual performance and socialisation processes. Students engage in group play experiences and individual skill learning exercises to integrate the concepts of movement education and their relationship to recreation, health and lifestyle.

15 5 2

OPTIONAL

COURSE NO. BRIEF DESCRIPTION NO. OF

CREDITSNZQA LEVEL

SEMESTER OFFERED

BRS5.36 Physical Fitness Assessment

This course provides students with knowledge, skills and understanding to carry out effective health and fitness assessment for the general and sporting populations. It incorporates understanding of how cardio respiratory fitness, muscular strength and endurance, body composition and flexibility contribute to health and/or reduce the risk of chronic disease. The focus of this course will be on providing students with the necessary practical skills for assessing individuals using a variety of health and fitness assessment methods.

15 5 1

BRS5.26 Principles of Physical Training

This course will develop the knowledge and skills underpinning the prescription of exercise programmes to enhance flexibility, strength, endurance, weight control and the cardiovascular health of human populations. Movement analysis and exercise prescription will be interpreted in the context of applied musculoskeletal anatomy.

15 5 2

DWRM5.07 Sports Massage

This course provides students with the skills required to prepare for, assess, conduct, record and review sports massage therapy.

15 5 2

Elective (Semester One/Two)

Students may select a relevant course from the EIT Elective Handbook. Students must have approval from the programme coordinator Sheryl-Lee Judd.

Please note that students will be required to check that an elective course does not create a timetable clash.

Full or Part-time Study

The Diploma in Recreation and Sport programme can be completed studying full-time or part-time. If you wish to study part-time, please contact the programme coordinator to discuss your study options.

All programme requirements must be completed within three years of entry into the programme.

© Eastern Institute of TechnologyDISCLAIMER: All information in this publication pertains to New Zealand Citizens or Permanent Residents, and is correct at the time of printing but is subject to change. EIT reserves the right to amend/withdraw programmes or courses. Fees for 2018 will be set by EIT Council by November 2017 and are subject to change. For the latest information, or for full programme entry requirements visit eit.ac.nz or phone 0800 22 55 348.

SCHOLARSHIPS AND GRANTSScholarships and grants make life easier by helping to cover your fees, other costs and living expenses while you study. You don’t always need to be an academic high-flyer to qualify.

EIT has a long list of scholarships for which you can apply. So if you would like to get financial help with your study, make sure you find out what’s available. You can also take a look online at the givME database available at EIT. It lists every scholarship and grant available in New Zealand.

STUDENT SERVICES LEVYThe Student Services Levy is a compulsory non-tuition fee that is charged to students enrolled at EIT. The levy is to contribute to the provision of quality student services that support learning. The funds received by EIT from the levy are ring-fenced, meaning they can only be spent on student services.

STUDENT LOANS AND ALLOWANCESStudyLink is a service of the Ministry of Social Development. Apply well before your programme begins (even if you haven't been accepted yet) so you'll be ready to get your payments when you need them most. Check out studylink.govt.nz or phone 0800 88 99 00. A Student Allowance is a weekly payment to help you with living expenses. It doesn't have to be paid back. A Student Loan is made up of three parts – compulsory fees, course-related costs and living costs. You have to pay these back.

ENROLMENT INFORMATIONHOW TO ENROL

Complete the enrolment form that was included with this info pack and return with all required supporting documents.

Or apply online www.eit.ac.nzApply to StudyLink if applicable, even if you haven't been accepted on to your programme yet. Visit www.studylink.govt.nz.

You may be contacted and invited to an interview.

You will receive an acceptance letter with programme information including your start date. It may also include course selection forms. You need to complete and return them.

You will receive an invoice with payment details.Arrangements for full payment of enrolment fees must be made before the start of your programme.

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THE EXPERIENCE YOU NEED & THE SUPPORT TO SUCCEED

DIPLOMA IN RECREATION AND SPORT 2018DOCUMENTATION / FORMS

Please Note The following documents need to be completed and returned

with your application/enrolment.

Without these documents we are unable to proceed with your application

• Brief Personal Statement including brief CV/Work History

• Consent for Disclosure of Information

• Health Declaration

• Police Vetting Form

DIPLOMA IN RECREATION AND SPORT 2018PERSONAL STATEMENT

(Handwritten please)

Name: ..................................................................................................................................................................................................................................................................

1. What do you believe are your personal strengths? ...........................................................................................................................................................................

....................................................................................................................................................................................................................................................................

....................................................................................................................................................................................................................................................................

2. How would you describe your attributes as a friend, a family member, or as a member of your community? ...................................................................................

....................................................................................................................................................................................................................................................................................................

....................................................................................................................................................................................................................................................................................................

3. Why are you interested in studying for a qualification in recreation and sport? ...........................................................................................................................................

....................................................................................................................................................................................................................................................................................................

....................................................................................................................................................................................................................................................................................................

4. Has your health ever affected your performance at work/school?

Yes No If yes, please comment: .....................................................................................................................................................................................................................................................

5. If you have worked/volunteered within the massage industry, please describe your experience and number of hours worked.

....................................................................................................................................................................................................................................................................................................

6. As part of this programme you may have practical experiences with agencies or organisations who may require you to obtain a Police vet of your personal information for any criminal convictions, criminal history, and details of fines and enforcements.

Have you ever had a criminal conviction?

Yes No Please note: A prior conviction may not necessarily exclude you from acceptance into the programme, but we may need to discuss it with you.

Do you have a First Aid Certificate that includes NZQA Unit Standards 6401, 6402 and 6400 or please list other First Aid Unit Standards.

Yes (a copy of this will need to be provided at time of application)

No

A First Aid Certificate is valid for two years from date of issue. If you do not hold a current First Aid Certificate you will have an opportunity to gain this as part of the programme.

Signed: ..............................................................................................................................................................................................................................................................................................

Date: .......................................................................................................................................

DIPLOMA IN RECREATION AND SPORT 2018HEALTH DECLARATION

Name: ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Should you have any questions about the level of health required to complete this programme please contact the programme co-ordinator prior to completing this declaration.

I declare that I have no medical, physical or psychological conditions that would significantly impact on my ability to participate in the practical and theory components of this programme. Should my health status change dramatically during my study I confirm I will make the programme co-ordinator aware of this change.

Signed: ______________________________________________________________________________________________________________________________________________________________ Date: _______________________________________________________________________________________________________________________________________________________

Vetting Service  Request & Consent Form

NZPVS‐CS ‐ 03/18 

Page 1 of 5 

Section 1:  Approved Agency to complete  (For more information please see the Guide to Completing the Consent Form‐ http://www.police.govt.nz/advice/businesses‐and‐organisations/vetting/forms‐and‐guides) 

Name of Approved Agency submitting vetting request: 

Name of Applicant to be vetted: 

Description of Applicant’s role: 

Applicant’s purpose 

 Employee          Contractor/Consultant     Volunteer          Prosecution  

 Vocational Training    Licence/Registration        Visa/Work Permit     Other 

What group(s) will the applicant have contact with in their role for your agency? 

 Children/Youth    Elderly   Other Vulnerable Adults   Other 

What is the applicant’s primary role for your agency? 

 Caregiving (Children)    Caregiving (Vulnerable adults)     Healthcare    Education 

 Other 

Is this request mandatory under the Vulnerable Children Act 2014 (VCA)? 

 Yes (VCA Core Worker)    Yes (VCA Non‐Core Worker) 

 No (mandatory under other legislation/optional/standard Police Vet) 

If this is a mandatory Vulnerable Children Act request, please specify the check reason below: 

 New Children’s Worker   Existing Children’s Worker 

 VCA Renewal  

Evidence of Identity (to be completed by agency representative/delegate or identity referee ‐ see guide for details) 

A primary ID has been sighted (Mandatory – see the guide for further details) 

A secondary ID has been sighted (Mandatory – see the guide for further details) 

One form of ID is photographic  (Mandatory – see the guide for further details) 

Evidence of name change has been sighted (if applicable) 

OR: If your organisation is able to accept a verified RealMe identity then: 

An assertion of a RealMe identity has been received (see guide for further information). 

In making this request, I confirm that: 

I have complied and will comply with the Approved Agency Agreement

I am satisfied with the correctness of the applicant’s identity

I have obtained the Applicant’s authorisation to submit this vetting request as set out in section 3 of this form

Approved Agency Authorised Representative:

Name:  Date: 

Signature:  Electronic Signature 

Vetting Service  Request & Consent Form

NZPVS‐CS ‐ 03/18 

Page 2 of 5 

Name of Approved Agency submitting vetting request: 

           

Section 2:  Applicant to complete and return to Approved Agency  

*Denotes a mandatory field 

Personal Information   

Details (note: the name you are most commonly known by is your primary name)     

*Family name (Primary):               

 

Given name(s):           

 

*Gender: (M)     (F)     (Other)  

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

             

 

Place of birth: (Town/City/State)               

     

*Country of Birth              

 

NZ Driver Licence number:               

        

Previous names: If applicable, please include other alias or alternate names; married name if not your primary name; previous/maiden/name changed by deed poll or statutory declaration. 

  Family name    First name    Middle names    

                                         

           

                                           

             

                                           

             

                                           

             

                                           

               

Permanent Residential Address  

*Number/Street:              

 

Suburb:              Post Code:              

 

*City/Town/ Rural District: 

            

 

 

Vetting Service  Request & Consent Form

NZPVS‐CS ‐ 03/18 

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Section 3:  Applicant to complete and return to Approved Agency   Consent to release information   

1. The New Zealand Police may release any information they hold relevant to the purpose of this vetting request. This includes: 

Conviction histories and infringement/demerit reports 

Active charges and warrants to arrest 

Charges that did not result in a conviction including those that were acquitted, discharged without conviction, diverted or withdrawn 

Any interaction I have had with New Zealand Police considered relevant to the role being vetted, including investigations that did not result in prosecution 

Information regarding family violence where I was the victim, offender or witness to an incident or offence, primarily in cases where the role being vetted takes place in a home environment where exposure to physical or verbal violence could place vulnerable persons at emotional or physical risk. 

Information subject to name suppression where that information is necessary to the purpose of the vet. 

2. If I am eligible under the Criminal Records (Clean Slate) Act 2004, my conviction history will not be released unless: 

a. Section 19(3) of the Clean Slate Act applies to this request (exceptions to the clean slate regime) 

b. Section 31(3) of the Vulnerable Children Act 2014 applies to this request (safety checks of core children’s 

workers).  

c. The vetting request is made by an individual for the purpose of an overseas Visa/Work Permit as a Privacy Act 

request authorising the vetting result to be provided directly to the relevant embassy, high commission or 

consulate. 

Please see the guide for more information regarding the Clean Slate legislation. 

3. The Police Vetting Service may disclose new relevant information to the Approved Agency after the completion of the Police Vet in the following circumstances: 

The disclosure of the newly‐obtained information is considered to be justified under the Privacy Act 1993 (if it had existed or been available at the time of the Police vet, it would have been disclosed); and 

The Police Vetting Service has ascertained that the purpose of the Police vet (e.g. employment role) still exists. 

The Vetting Service will endeavour to notify you prior to the disclosure. 

4. Information provided in this consent form may be used to update New Zealand Police records. 

5. I am entitled to a copy of the vetting result released to the Approved Agency (to be provided by the agency) and can seek a correction by contacting the Vetting Service. 

6. The Approved Agency will securely dispose of this consent form, copies of identification documents  and the vetting result within 12 months of receiving the result unless a longer retention period is required by legislation. 

7. I may withdraw this consent, prior to Police’s disclosure of the vetting result, by notifying the Approved Agency. 

For further information, please see the Guide to Completing the Consent Form. 

Applicant’s Authorisation: 

  I confirm that the information I have provided in this form relates to me and is correct. 

  I have read and understood the information above.  

  I authorise New Zealand Police to disclose any personal information it considers relevant to my application (as described above) to the Approved Agency making this request for the purpose of assessing my suitability at any time. 

Name:              Date:           

 

Signature: 

   

Electronic Signature 

Vetting Service  Request & Consent Form

NZPVS‐CS ‐ 03/18 

Page 4 of 5 

Section 4:  Applicant to complete for Australian check (if required) 

Additional Personal Information (for Australian National Police History Check)  Last Permanent Australian Residential Address 

Number/Street:             

Suburb:              Post Code:             

City/Town/ Rural District: 

           State or Territory: 

           

Period of Residence Start date: 

           Period of Residence End date: 

           

Australian Driver's Licence No: (if applicable) 

           Issued by: 

           

Australian Firearms Licence No: (if applicable) 

           Issued by: 

           

CONSENT TO DISCLOSURE 

General Information for an Australian National Police History Check  General Information Australian Criminal Intelligence Commission (ACIC) is collecting your personal information in this form in order to conduct a National Police History Check (NPHC) on you. Approved Agencies in New Zealand, named in section one, use the personal information collected on this form and the resulting NPHC as part of the assessment process to determine suitability for the position/entitlement/benefit which you are applying for. 

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 or  to maintain  the  records of ACIC, 

Australian Police Agencies1, or NZ Police.  

You will be required to complete another consent form for any future NPHC checks. 

National Police History Check (NPHC) A NPHC is an integral part of the assessment of your suitability. Information on this form will be used by ACIC, and Australian Police Agencies for checking action; it will also be used to update records held about you by ACIC, Australian Police Agencies and NZ Police.  Information released may include outstanding charges, warrant information and criminal convictions/findings/pleas of guilt recorded against you that may be disclosed according to the laws of the relevant jurisdiction and, in the absence of any laws governing the release of that information, according to the relevant jurisdiction information release policy. 

Limitations on accuracy and use of Police History Information While every care has been taken by ACIC to conduct a search of information held by Australian Police Agencies that relate to the applicant, the accuracy and quality of this NPHC depends on accurate identification of the Applicant (including aliases) according to the information provided in the Request and Consent Form and the comprehensiveness of police records. If the applicant does not complete the information requirements in this form the success and validity of the NPHC will be compromised. 

If for any reason you do not agree with the results of your NPHC, please notify the Approved Agency that you submitted the check through in the first instance, so that the NPHC dispute process can be initiated.  

The release of information by Australian Police Agencies is subject to relevant Spent Convictions, non‐disclosure legislation or information release policies.

Spent Conviction Schemes  The aim of Spent Convictions legislation2 is to prevent discrimination on the basis of certain previous convictions. Spent Convictions legislation limits the use and disclosure of older, less serious convictions and findings of guilt. Each Australian Police Agency will apply the relevant Spent Convictions legislation/information release policy prior to disclosure. 

General Information for an Australian National Police History Check, (continued) 

1 Australian Federal Police, ACT Policing, The New South Wales Police Force, Queensland Police Service, South Australia Police, Victoria Police, Western Australia Police,

Northern Territory Police Force, Tasmania Police Service 2 Applicable Spent Conviction legislation, as amended from time to time

Vetting Service  Request & Consent Form

NZPVS‐CS ‐ 03/18 

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The following links may be helpful in sourcing information on Spent Convictions in the Australian States & Territories but may not be relied upon.   If further information or clarification is required please contact the individual Australian Police Agencies directly for further information about their release policies and any legislation that affects them. 

Commonwealth  www.comlaw.gov.au  New South Wales www.legislation.nsw.gov.au  Queensland www.legislation.qld.gov.au  

South Australia www.legislation.sa.gov.au  Victoria Police www.police.vic.gov.au  Tasmania  www.thelaw.tas.gov.au 

Western Australia   www.slp.wa.gov.au  Northern Territory ‐www.nt.gov.au/dcm/legislation/current.html  Australian Capital Territory www.legislation.act.gov.au  

Provision of incomplete, false or misleading information An Approved Agency or Applicant must take reasonable steps to ensure that the personal information collected, or disclosed is accurate, complete and up to date. 

You are asked to certify that the personal information 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 incomplete, false or misleading information, you may be assessed as unsuitable. 

It is a serious offence to provide false or misleading information in Australia. 

Consent to disclosure (for Australian National Police History Check) 1. I have read the General Information in section 3 of this form and understand that information will be disclosed in accordance 

with applicable legislation and information release policies (including spent convictions legislation, however described) in the Commonwealth, States and Territories;  

2. I understand that the position/entitlement for which I am being considered may be in a category for which exclusions from Spent Convictions legislation may apply; 

3. I 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; 

4. I acknowledge that the provision of false or misleading information is a serious offence; 

5. I acknowledge that the Approved Agency named in Section 1 of this form is collecting information in this Form to provide to New Zealand Police to provide to ACIC (an Agency of the Commonwealth of Australia) and the Australian Police Agencies; 

6. I consent to: a. ACIC using and disclosing personal information about me in this form to the Australian Police Agencies; 

b. the Australian Police Agencies disclosing to ACIC, from their records, Police History information that can be disclosed in accordance  with  the  laws  of  the  Commonwealth,  States  and  Territories  and  in  accordance  with  the  relevant jurisdiction’s information release policies; 

c. ACIC disclosing the information disclosed by the Australian Police Agencies to New Zealand Police, and 

d. New Zealand Police disclosing any criminal history information about me to the Approved Agency named in Section 1 of this form to assess my suitability in relation to my application; 

7. I acknowledge that any information provided by me in this form relates specifically to the purpose identified in Section 1 of this form; 

8. I acknowledge that any information provided by the Australian Police Agencies or ACIC relates specifically to the purpose identified in Section 1 above; 

9. I acknowledge that personal  information that  I provide  in this form may be disclosed to the Approved Agency named  in Section 1 of this form (including contractors or related bodies corporate) located in New Zealand or overseas; and 

10. I acknowledge that it is usual practice for an Applicant's personal information in this form to be disclosed to New Zealand Police  and  Australian  Police  Agencies  for  them  to  use  for  their  respective  law  enforcement  purposes  including  the investigation of any outstanding criminal offences. 

Note: The information provided in this form will be used only for the purpose stated above unless statutory obligations require otherwise. 

Applicant’s Authorisation:  

  I have read and understood the information above and consent accordingly. Signed in electronic form     

or, Signature: ____________________________                                                                             Date: