Working with Children Check
Summary – Interstate application requirements
Next steps
1. Print the application
summary
Applicants for an Employee Check
must also print the payment form.
2. Prepare your proof of
identity documents
• You must provide three identity
documents that together identify you
by your full name, date of birth and
photo. You can use any one of the
following combinations:
1. One primary document and two
secondary documents
2. Two primary documents and one
secondary document, or
3. Three primary documents.
• One acceptable combination is an
Australian driver’s licence, a Medicare
card, and a credit or account card*.
You could also use an Australian
birth certificate, a tertiary student ID
card, and a proof of age card. You
cannot use two of the same type of
identity documents to make up the
three documents (for example, two
different credit cards).
• Photocopy your documents, and take
them, along with the originals, to a
certifying officer.
3. Supply photos
• You must provide two passport-size
photos that meet the requirements
listed on the website. For further
details, refer to the Interstate applicant
information guide. One photo must be
certified on the back by the certifying
officer stating the photo is a true
likeness of you.
* American Express and Diners Club cards are not accepted.
4. Have your documents certified
Ask a certifying officer, such as a Justice of
the Peace, to:
• certify the copies of your documents and one
of the passport size photos.
• complete their declaration on the application
summary.
5. Ready to lodge your application?
You need to mail the following to the
department:
Your completed application
summary
Copies of your identity documents
certified as true copies of the
originals
Two passport-size photos, one
certified on the back
A completed payment form, if you
are applying for an Employee
Check
6. Mail your application to:
Working with Children Check Victoria
Department of Government Services
GPO Box 1915
Melbourne VIC 3001
We will email you an acknowledgement once
we receive your application.
For further information, refer to the Interstate
applicant information guide
If you require assistance, please call
1300 652 879 during business hours.
 Application number: 2821082A

Working with Children Check Victoria

Working with Children Check - Employee Application summary

Important instructions: DO NOT make changes to this document, as it will not be accepted if it has been
amended.
We MUST receive this document before 29/07/2023 . An Employee (E) card fee is $128.20.

Name : Haimin WANG

Date of Birth: 01/06/1995

Current residential address: BA029 Building 955, 100 Clyde Road

Berwick VIC 3806

Current postal address: BA029 Building 955, 100 Clyde Road

Berwick VIC 3806

Previous names:

Contact phone numbers: Mobile: 0466268598

Applicant’s photo and certifying officer's declaration

I confirm and declare that I have: Secure photo face up

• certified the photo as a true likeness of the

applicant.
DO NOT FOLD
• certified the copies of the applicant's proof
THROUGH PHOTO
of identity documentation, confirmed they are
current, and that they match the name and
date of birth on the application.

Certifying officer's name

Certifying officer's signature

Date certified
D D M M Y Y Y Y
Working with Children Check Victoria
Payment form
Haimin WANG
Application number: 2821082A
Please complete this form and attach to your completed application form. The non-refundable fee for an
Employee application is $128.20.

Privacy statement

We are bound by Victorian privacy laws ( Privacy and Data Protection Act 2014 and Health Records Act
2001 ). For details go to our website: workingwithchildren.vic.gov.au.

Payment options

Please select your preferred payment option.

Please note that cash payments, personal and business cheques cannot be accepted.

MasterCard Visa Bank cheque Money order

American Express and Diners cards are not accepted Payable to: Department of Government Services Victoria

Credit card authorisation

Credit card number Expiry date

M M Y Y

NOTE: Your credit card details are not retained after your payment is processed

Name on credit card

Cardholder's signature

Date Amount
D D M M Y Y Y Y $

Office use only

Date payment taken Receipt Number