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Department of Communities, Disability Services and Seniors
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- Forms
- Application for eligibility declaration (Form 10-10)
Application for eligibility declaration (Form 10-10)
Purpose
For use by a disqualified person seeking to be declared eligible to apply for a prescribed notice.
- Application for eligibility declaration (Form 10-10) Application for eligibility declaration (Form 10-10)
Checklist
- Check that your details are correct
- Complete the declaration
- Complete the payment details section (Part E)
- If payment is by credit card, please pay online via:
Make a Yellow Card Application payment - Ensure all signatures are on the form
- Have your identification documents certified 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.
- Last reviewed
- 6 June 2018
- Last modified
- 29 March 2019
This work is licensed under a Creative Commons Attribution 4.0 International (CC BY 4.0) licence