Please read the instructions in this guideline prior to completing your application form for a Working with Children Clearance. Failure to complete the form appropriately will result in the form being returned to you for amendment. If you do not understand any instruction or have questions about the completion of the Application Form, please contact SAFE NT on telephone 1800 723 368.
Do you have the right form?
As part of the screening process involves a National Criminal History Record Check, it is very important you complete this section fully. It is mandatory to provide your Full name, Date of Birth, Town/City, State and Country of Birth, and a Current Residential Address. Without these details, your application cannot be processed and will be returned to you. Please list any other names that you have ever been know as. This important information will inform the National Police Check process, and help ensure correct identification where there is more than one candidate with the same name. Your Postal Address will be used to forward any communication from the Screening Authority, including your Clearance Notice and Ochre Card. Ensure this section is completed if you currently reside outside of the Australia Post delivery area.
Providing previous residential addresses can assist with ensuring that the name matching done as a part of the National Police Check process is correct, and that no details are attributed to your name that are not a part of your own history. Please list previous addresses for the past 5 years, starting with the most recent but not including your current address. If you cannot remember exact details, just note the approximate years and town/State of residence. Attach a separate page if you require further space.
Your Clearance Notice will be accompanied by an Ochre Card that carries your photo and personal details. Do not staple this photo to the form. As you are required to provide one certified copy of a piece of photographic identification, e.g. your drivers licence or passport, you do NOT need to have the back of this photo certified.
Photos should meet the following standards.
A detailed Photograph Guidelines fact sheet is available for more information.
If you lodge your form in person at the SAFE NT office in Darwin, you will be able to have your photo taken on site.
The requirement to get a clearance notice applies only to certain categories of employment that are defined under the Care and Protection of Children Act to be 'child-related work'. From the list below, select the number of the category that most applies to the current employment or potential employment situation you will be in and insert that number into the form.
| 1 | Child protection services provided by or for the NT Department of Health and Families |
| 2 | Children's services including child care, family day care and after school hours care |
| 3 | Educational facilities for children, including government schools and non-government schools and extra curricular activities. This includes teachers, teachers aides, administrative staff, caretakers and volunteers who work at the school or on activities associated with the school |
| 4 | Juvenile detention centres |
| 5 | Refuges or other residential facilities used by children, including safe houses, women's shelters and youth residential programs |
| 6 | Hospital wards or any other facilities for health or emergency services in which children are ordinarily patients. This includes medical staff, allied health staff, cleaners and ward administration staff |
| 7 | Clubs, associations or movements with significant child membership or involvement, including groups that are of cultural, recreational or sporting nature |
| 8 | Religious organizations and vocations |
| 9 | Babysitting or child-minding services |
| 10 | Fostering of children |
| 11 | Students on placement in work as part of their studies including student teachers and child care workers |
| 12 | Transportation services for children |
| 13 | Private tuition services for children, including music, dance or education tuition and coaching for individuals or groups. |
| 14 | Counselling or other support services for children |
| 15 | Overnight camps for children |
| 16 | Road crossing services for school children |
| 17 | Sports coaching or sports lessons for children |
| 18 | Accommodation services for children in private residential premises, including home hosting for exchange students and boarding facilities for students |
| 19 | Gym or play facilities, photographic services, talent or beauty competitions, entertainment or party services that are a provided or arranged for children |
If new information which affects your suitability to continue working with children arises during the validity of your clearance notice, SAFE NT is required under the Act to contact your employer. SAFE NT needs to be able to do this, as it is an offence for employers to permit a person without a valid clearance notice to engage in child-related work.
Please note, that the original information obtained by the Screening Authority as a part of the assessment is confidential and will not be to your employer. Your employer will not get a copy of your criminal history record or any other material you provide to the Screening Authority.
Employees of the NT Government are encouraged to provide your AGS number with this application. SAFE NT will be able to notify your manager through the government PIPS system of the issue of a Clearance Notice. If you do not provide this information, you will be required to present your clearance notice to your employer as evidence of your compliance with the Act. You can find your AGS number by logging into MyHR or seeking advice from your HR area.
If you are currently seeking employment with the NT Government you are asked to please notify SAFE NT upon commencement with your employer, of the new AGS number that they provide to you. SAFE NT will update your details to send back to the Agency to comply with reporting requirements.
Your Clearance Notice and Ochre Card will be sent to your personal Postal Address. It is your responsibility to give a copy to the organisation that will employ you in a voluntary capacity if they request it. However, SAFE NT is required by law to notify anyone that employees you (in a paid or voluntary capacity), if there are certain changes to your circumstances that affect your suitability to hold a Clearance Notice for child-related work.
If you intend on volunteering to work with more than one Agency or organisation, you should list the organisation with which you will spend the most time in this section. You do not need more than one Clearance Notice/Ochre card.
Should you gain paid employment during the validity of holding a clearance notice for voluntary engagement in child-related work, you will required to apply for a Clearance Notice for Employment when you come to renew the notice.
As the fee for a check is subsidised by the NT Government for volunteers only, SAFE NT requires the Manager or Director of the organisation you are to work with to certify that you will receive no financial gain, payment or benefit. If a false or misleading declaration is made in this form, this may affect your ability to hold a Clearance Notice.
Please read this section carefully prior to signing this declaration. If you are unsure of the meaning of this section, please seek legal advice. Failure to sign this form will mean that SAFENT cannot process your application and the form will be returned to your nominated postal address.
If you are lodging this application in person at SAFE NT or at a Territory Business Centre, this section will be completed by staff at that venue.
If you are mailing your application, then SAFE NT needs to be sure that you have met the 100 point of ID requirement for identity verification. This can be done by a number of people, who are identified in legislation to be 'Qualified Persons'.
| 1 | Staff of Territory Business Centres |
| 2 | Justice of the Peace |
| 3 | Commissioner for Oaths or notary public |
| 4 | Police Officer or Auxiliary in the NT, Police officers of the rank of sergeant or above in any other State or Territory |
| 5 | Legal Practitioner or Judge or Magistrate appointed to an Australian Court |
| 6 | Medical Practitioner |
| 7 | Area Service Manager or Health Centre Manager of the NT Department of Health and Families |
| 8 | Principal (however described) of an Australian educational facility |
| 9 | General Manager, Schools Manager or Branch Head of the NT Department of Education and Training |
| 10 | Chief Executive Officer or member of a council constituted under the Local Government Act, i.e. an elected member of a Local Government Council |
All documents must be current, or valid. Expired documents or licences cannot be accepted as evidence of identity. The applicant must provide originals or certified copies of documents from the list below to the total of 100 points. This must include one (1) Primary Document. If a primary document is not available, the 100 point check cannot be met.
| Primary Document | Point Value |
| Australian Passport | 70 |
| Licence or permit issued by the Commonwealth or a State or Territory that specifies date or birth and contains a photo. e.g Firearms licence, MSIC or ASIC licence | 40 |
| Proof of Age Card issued by any Australian State or Territory | 40 |
| Identity document issued by an Aboriginal Land Council containing a photograph | 40 |
| Birth Certificate | 70 |
| Australian Citizenship certificate | 70 |
| An original statutory declaration confirming the candidate's identity that is in the approved form by a person who has known the candidate for at least 12 months. This must contain a photograph of the candidate, and be made no more than three months prior to application submission. (see website for further details) | 40 |
| Secondary Documents | Point Value |
| Working with children clearance notice Ochre Card | 40 |
| Commonwealth or State or Territory government employee identification card containing a photograph | 40 |
| Medicare card, health care card, centrelink card | 25 |
| Credit card, debit card or passbook - one per Bank | 25 |
| Council rates notice (with name and current residential address) | 25 |
| Utilities notice (with current residential address) | 25 |
| Foreign drivers licence | 25 |
If the applicant is between 15 and 18 years of age only one primary document from the list above is required to fulfil the requirements for verifying identity. If the applicant does not have a primary document from the list, SAFE NT will accept an original statutory declaration confirming the applicants identity that has a photograph attached and is made no more than 3 months before the date of the lodgement of the application by the principal of an Australian educational facility at which the youth is enrolled.
Persons under 15 years of age do not require a working with children clearance
The fees for a Working with Children Clearance check are:
Payment must be received prior to the application form being processed. If an incorrect payment amount is made, the payment and form will be returned to the applicant.
Please do not send cash through the mail. Cheques or money orders should be made payable to the Receiver of Territory Monies (RTM). If you are completing the credit card authorisation, ensure you complete each field in this section.
If you have any questions about the application form please contact Screening Assessment For Employment (SAFE NT) by: