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


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.


  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

Further information

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