11Applicant’s Declaration#
I consent to the department verifying my EOI information and using my personal information, digital photo and digitised signature for the purposes associated with my application for a Traffic Controller Accreditation. I declare that I have read the above statement and that the answers given by me are complete, true and correct in every detail. I understand that any false, misleading or incorrect information provided by me may result in the immediate cancellation of the Traffic Controller Accreditation.
Consent to conduct enquiries#
In making this application, I give my consent for TMR to conduct enquiries it deems necessary to determine if I meet the suitability requirements for Traffic Controller Accreditation and to conduct such enquiries during the period of my accreditation to assess my ongoing suitability to hold a Traffic Controller Accreditation. Including, but not limited to:
- a national criminal history check (charges including those yet to be determined, convictions and certain investigative and disciplinary information) through the QPS. I authorise the release of that information by the QPS and the Australian Federal Police to TMR
- a New Zealand (NZ) criminal history check if deemed required. I authorise the NZ Police to release any information they hold relevant to my application. I acknowledge that the Criminal Records (Clean Slate) Act 2004 (NZ) may not apply and that my NZ conviction history may be released. (For details about what your consent includes please read Section 3 of the Vetting Service Request and Consent Form which can be obtained from ww.police.govt.nz)
- a driving history check in all states and territories of Australia
- enquiries with the courts, police, prosecuting authorities or other relevant bodies or entities to enable TMR to make a full and informed assessment of my suitability for a Traffic Controller Accreditation
- verifying evidence of identity information provided in this application.
- Where relevant to the processing of this application, I consent to my registered health professional disclosing information about my physical and mental capacity to perform the role to TMR.
- I give my consent to TMR taking, keeping and using my personal information, including information about my medical fitness to perform the role, for the issue of an accreditation under the Transport Operations (Road Use Management) Act or otherwise authorised by law.
I authorise TMR to use this information to maintain a database which is used to monitor transactions and to provide other government agencies with information relating to my Traffic Controller accreditation. I give my consent to TMR taking, keeping and using personal information for the issue of a Traffic Controller accreditation under the Transport Operations (Road Use Management) Act or otherwise authorised by law.
Responsibilities as a traffic controller#
I understand my responsibilities as a traffic controller under the Transport Operations (Road Use Management) Act. I understand that failure to comply with the statutory accreditation conditions and the Traffic Controller Accreditation Scheme Approved Procedure may result in the suspension or cancellation of my accreditation as a traffic controller.
Sign only in the presence of a departmental officer.
Applicant’s signature SIGN Date
Authorising Person’s Declaration#
I declare that:
- I have witnessed the applicant’s signature.
- I am satisfied that the signature accords satisfactorily with the signature appearing on the EOI document/s.
- I have also sighted EOI, and the Change of Name documents as required.
Authorising person’s name Authorising person’s signature SIGN Date Office stamp
| Office Use Only | ||
|---|---|---|
| (a) The applicant has applied for – Traffic Controller Accreditation Renewal of Traffic Controller Accreditation | ||
| (b) Fee paid | Amount paid | Receipt number |
| $ | ||
| (c) Has the relevant driver licence been sighted and EOI verified? | Yes | No |
| (d) Has a 1:1 match been performed? | ||
| IL Hub to complete the following for NEW applications only | ||
| (e) Does the applicant meet the licensing requirements? | ||
| (f) Is the applicant’s traffic history check satisfactory for accreditation? | ||
| (g) Is the applicant’s criminal history check satisfactory for accreditation? | ||
| (h) Is the person mentally and physically an appropriate person to be accredited? (See section 9 on this form) | ||
| (i) Has the applicant completed the required training? (See section 8 on this form) | ||
| (j) Do you recommend that this application be approved? | Yes Yes with conditions No attach a copy (attach a copy of the refusal of the condition letter with this letter with this application application) | |
| Recommended by | Date / / | |
| Approved by | Date / / | |
| Refused by | Date / / |
Table in words
- Office Use Only: (a) The applicant has applied for – Traffic Controller Accreditation Renewal of Traffic Controller Accreditation.
- Office Use Only: (b) Fee paid, Amount paid, Receipt number.
- Office Use Only: (c) Has the relevant driver licence been sighted and EOI verified? Yes No.
- Office Use Only: (d) Has a 1:1 match been performed?.
- Office Use Only: IL Hub to complete the following for NEW applications only.
- Office Use Only: (e) Does the applicant meet the licensing requirements?.
- Office Use Only: (f) Is the applicant’s traffic history check satisfactory for accreditation?.
- Office Use Only: (g) Is the applicant’s criminal history check satisfactory for accreditation?.
- Office Use Only: (h) Is the person mentally and physically an appropriate person to be accredited? (See section 9 on this form).
- Office Use Only: (i) Has the applicant completed the required training? (See section 8 on this form).
- Office Use Only: (j) Do you recommend that this application be approved? Yes Yes with conditions No attach a copy (attach a copy of the refusal of the condition letter with this letter with this application application).
- Office Use Only: Recommended by, Date / /.
- Office Use Only: Approved by, Date / /.
- Office Use Only: Refused by, Date / /.