Diploma in Recreation and Sport For New Zealand Citizens & Permanent Residents. eit.ac.nz EASTERN INSTITUTE OF TECHNOLOGY

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1 2018 For New Zealand Citizens & Permanent Residents Diploma in Recreation and Sport 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: sjackson@eit.ac.nz EASTERN INSTITUTE OF TECHNOLOGY eit.ac.nz

2 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 OPPORTUNITIES For 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 KNOW Diploma 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 PARTNERSHIPS We value our partnership with students and aim to provide quality education in a supportive environment, encouraging personal growth and professional development.

3 KEY DATES INTAKE ONE INTAKE TWO Programme starts Monday, 19 February Programme starts Monday, 23 July Semester ends Friday, 29 June 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 TIMETABLE Your 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 TIME On-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 TIME Students 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 CRITERIA All 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 REQUIREMENT Applicants 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 CREDIT You 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) TRANSFERS/CROSS CREDITS A 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.

4 FACILITIES Practical 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 GYM Included 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. ASSESSMENTS Assessments include essays, written reports, assignments, and written and practical examination. DEGREE ELECTIVES Students 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 SUCCEED When 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 STAFF The Tertiary Education Commission rates EIT as one of New Zealand s top two institutes of technology and polytechnics for research. Our highlyqualified 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 Sheryl-Lee Judd Programme Coordinator Recreation and Sport Lee-Anne Taylor Assistant Head of School / Lecturer Recreation and Sport Dr Carl Paton Senior Lecturer Recreation and Sport Diana Kirton Practicum Manager Sue Scott-Chapman Senior Lecturer Recreation and Sport QUALIFICATION Dip. Health Sciences, ACAT, PGCertHSc MHSc(Rehab), BPhty, BSc Ph.D, MSC, BSC, PG Cert Ed. BA (Psyc) BSpLS (Honors), PhD NAME Gail Maxey Senior Lecturer Science Edmond Otis Senior Lecturer Recreation and Sport Dr Patrick Lander Senior Lecturer Recreation and Sport Maria Pearson Senior Lecturer Recreation and Sport Adam Blake Lecturer Recreation and Sport QUALIFICATION BSc, Dip.PE, Dip.Tchg MS, MFT (Licensed Clinical Psychotherapist) PhD, MSc, BSc (Hons), CATA. BPhEd, PGDipPE, MPhEd BRS

5 COURSE DESCRIPTIONS COMPULSORY COURSE NO. BRS5.51 AP4.11 BRS5.45 BRS5.20 BRIEF DESCRIPTION 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. 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. 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. 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. NO. OF CREDITS NZQA LEVEL SEMESTER OFFERED Organisation and Management BRS5.21 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. 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

6 OPTIONAL COURSE NO. BRS5.36 BRS5.26 DWRM5.07 BRIEF DESCRIPTION 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. 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. Sports Massage This course provides students with the skills required to prepare for, assess, conduct, record and review sports massage therapy. NO. OF CREDITS NZQA LEVEL SEMESTER OFFERED 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.

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8 ENROLMENT INFORMATION HOW TO ENROL STEP ONE Complete the enrolment form that was included with this info pack and return with all required supporting documents. STEP TWO You may be contacted and invited to an interview. STEP THREE You will receive an invoice with payment details. Arrangements for full payment of enrolment fees must be made before the start of your programme. Or apply online Apply to StudyLink if applicable, even if you haven't been accepted on to your programme yet. Visit www. studylink.govt.nz. 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. SCHOLARSHIPS AND GRANTS Scholarships 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 LEVY The 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 ALLOWANCES StudyLink 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 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. Eastern Institute of Technology THE EXPERIENCE YOU NEED & THE SUPPORT TO SUCCEED DISCLAIMER: 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

9 DIPLOMA IN RECREATION AND SPORT 2018 DOCUMENTATION / 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

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11 DIPLOMA IN RECREATION AND SPORT 2018 PERSONAL STATEMENT (Handwritten please) Name: What do you believe are your personal strengths? How would you describe your attributes as a friend, a family member, or as a member of your community? Why are you interested in studying for a qualification in recreation and sport? Has your health ever affected your performance at work/school? Yes No If yes, please comment: If you have worked/volunteered within the massage industry, please describe your experience and number of hours worked 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 No (a copy of this will need to be provided at time of application) 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:...

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13 DIPLOMA IN RECREATION AND SPORT 2018 HEALTH DECLARATION Name: Should you have any questions about the level of health required to complete this programme please contact the programme coordinator 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:

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15 Vetting Service Request & Consent Form NZPVS CS 03/18 Section 1: Approved Agency to complete (For more information please see the Guide to Completing the Consent Formhttp:// 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: Signature: Date: Electronic Signature Page 1 of 5

16 Vetting Service Request & Consent Form NZPVS CS 03/18 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: Page 2 of 5

17 Vetting Service Request & Consent Form NZPVS CS 03/18 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 Page 3 of 5

18 Vetting Service Request & Consent Form NZPVS CS 03/18 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/ State or Territory: Rural District: Period of Residence Period of Residence Start date: End date: Australian Driver's Licence No: Issued by: (if applicable) Australian Firearms Licence No: Issued by: (if applicable) 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 Agencies 1, 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 Page 4 of 5

19 Vetting Service Request & Consent Form NZPVS CS 03/18 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 New South Wales Queensland South Australia Victoria Police Tasmania Western Australia Northern Territory Australian Capital Territory 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: Page 5 of 5