Application for criminal history screening (exemption notice) (Form 10-11)

Purpose

For use by a Department of Communities, Disability Services and Seniors funded non-government service provider or a National Disability Insurance Scheme (NDIS) non-government service provider on behalf of a blue card holder engaged or seeking to be engaged by the service provider.

• Application for criminal history screening (exemption notice) (Form 10-11) (PDF, 305 KB) Application for criminal history screening (exemption notice) (Form 10-11) (DOC, 315 KB)

Checklist

1. Check that your details are correct
2. Complete the declaration
3. Ensure all signatures are on the form
4. If you are a sole trader, your identification documentation must be witnessed by a justice of the peace.

Submitting your request

• Mail: Department of Communities, Disability Services and Seniors
  PO Box 10179, Adelaide Street Brisbane QLD 4000
• Email: criminalhistoryscreening@disability.qld.gov.au

Further information

If you have any questions please email Criminal History Screening or phone the criminal history screening hotline: 1800 183 690