Department of Communities, Disability Services and Seniors

Application for eligibility declaration (Form 10-10)


For use by a disqualified person seeking to be declared eligible to apply for a prescribed notice.


  1. Check that your details are correct
  2. Complete the declaration
  3. Complete the payment details section (Part E)
  4. If payment is by credit card, please pay online via:
    Make a Yellow Card Application payment
  5. Ensure all signatures are on the form
  6. Have your identification documents certified 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.