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International Criminal Record Check - Philippines

Consent to Obtain Personal Information

General Information
This form is used by Equifax Australasia HR Solutions Pty Limited as part of the assessment process
to determine whether a person is suitable for employment or other engagement for work with your
current / potential employer.

Unless statutory obligations require otherwise, the information provided on this form will not be used
without your prior consent for any purpose other than in relation to the assessment of your suitability.
You may be required to complete another consent form in the future in relation to employment in other
positions within your current or potential employer.

Provision of False or Misleading Information


You are asked to certify that the personal information that you have provided on this form is correct. If
it is subsequently discovered for example as a result of a check of police records that you have
provided false or misleading information, you may be assessed as unsuitable.

You should note that the existence of a record does not mean that you will be assessed automatically
as unsuitable. Each case will be assessed on its merit, so it is in your interest to provide full and frank
details in the form

Instructions for Completing this Form


Print and complete both pages of this form. Please complete all sections of the form that are relevant
to you. Once completed, scan or photograph this form and one identification document, such as
current passport, driver’s licence, student card, medical card or other form of ID.

Email these images to info-eev@equifax.com

Consent to Obtain Personal Information

I hereby:

1. Acknowledge that I have read the consent form and understand the purpose for which this
consent is provided.

2. Have fully completed this form, and the personal information I have provided in it relates to me,
contains my full name and all names previously used by me, and is correct.

3. Consent to Equifax Australasia HR Solutions Pty Limited disclosing personal information about
me from this form to any partner organisations involved in completing the check.
International Criminal Record Check – Philippines
Consent to Obtain Personal Information

4. Consent to Equifax Australasia HR Solutions Pty Limited disclosing to my current or potential


employer personal information about me to assess my suitability in relation to my employment.

5. Acknowledge that any information provided by me on this form may be taken into account by my
current or potential employer in assessing my suitability for the position for which I am applying.

I have read and understood the above. I agree to these conditions for the check to be conducted by
Employment Verification and subsequent release of this information to the entity who ordered the
check. I hereby release Employment Verification from any liability arising from a result of furnishing
that information, save for any liability arising from an obligation to me that Employment Verification
may have under either the Australian Privacy Act 1988 or the New Zealand Privacy Act 1993.

Signed:

Date:

Personal Details

Surname Given Names

Other known names / maiden name (also names known in Phillipines) Date of Birth

Please list Philippines ID types and numbers below, starting with Passport details.
This section is mandatory. Also indicate the type of document (passport, driver’s licence, medical
card) followed by the number on that document.

Document Type Document Number

Hong Kong ID

Document Type Document Number

Document Type Document Number

2
International Criminal Record Check – Philippines
Consent to Obtain Personal Information

Please list all of your residential addresses in the previous 10 years


starting with your current address. If you need more space, please attach an additional page. This
section is mandatory.
Period of Residency
Address 1 From Date To Date

Address 2

Address 3

Address 4

Address 5