Application for a Child Safety and Personal History Screening Check LCS Form – 2

This form is to be completed by persons who’s suitability may be investigated under Chapter 4, Part 2, Division 7 of the Child Protection Act 1999 and Part 7 of the Child Protection Regulation 2011. Please Note: The Child Protection Regulation 2011 provides for the Department of Communities, Child Safety and Disability Services to consider any relevant matter to help the department decide the suitability of the nominee. The Licensee must consider relevant information provided by the department about Director/s, Manager/s and persons engaged in relation to the provision of care services by a licensed care service when deciding suitability

1Part 1: Organisation Information

2Part 2: Applicant Information

3Part 3: Address History in the Last 5 Years

4Part 4: Privacy and Consent

5Part 5: Proof of Identity

6Part 6: Identification Documents Sighted and Verified

7Part 7: Personal History Check of Applicant

Part 1: Organisation Information

Organisation Name:

(current registered name)

Organisation ID (LIS):

Licence Number:

(If organisation is currently licenced)

Date Properly Made:

(If organisation does not have a current licence)

Correspondence Information
(NB: this is to whom the Notification of Child Safety and Personal History Screening outcome letter will be emailed)

Contact Person:

Phone Number:

Postal Address:

Postcode:

Email Address:

Part 4: Privacy and Consent

Privacy Notice:

The Department of Communities, Child Safety and Disability Services is undertaking Child Safety and Personal History Screening to assist in determining your suitability to be engaged in the provision of care services by licensed out-of-home care service providers.

This information is collected under the Child Protection Act 1999 and the Child Protection Regulation 2011 and is usually given to the Queensland Police Service, Department of Transport and Main Roads and the Public Safety Business Agency.

In circumstances where an interstate or international child protection check is required, your personal information may be provided to the government agency responsible for child protection in other Australian States and Territories and also to International Social Service Australia and the Department of Child, Youth and Family Services (NZ).Your personal information will be handled in accordance with the Information Privacy Act 2009 (Qld).

Guidelines

The Child Protection Act 1999 provides for the Department of Communities, Child Safety and Disability Services to obtain particular information to assist in deciding and monitoring the suitability of the Nominee, Directors, Manager and persons engaged in the provision of care services provided by the organisation. The information obtained will relate to child protection history, domestic violence history and traffic history.

The Child Protection Regulation 2011, Part 7 provides further clarification of the definition of a “suitable person” by role. Please refer to this for full suitability criteria (see page 6).

Applicant to read and sign consent.

I consent to the Department of Communities, Child Safety and Disability Services and the Government Departments and Agencies designated in the above Privacy Notice to undertake child protection, domestic violence and traffic history checks. I have read and understood the Privacy Notice above, and confirm that the information in the application is correct.

Name of Applicant:

Signature of Applicant:

upload the scanned signature

Date Signed:

Part 7: Personal History Check of Applicant

Guidelines

Child Protection checks will be conducted in the first instance. However the department may conduct domestic violence and traffic history checks where it is considered necessary to determine if a person is a suitable person under the Child Protection Act 1999.

Domestic violence checks will include where a person was a respondent to a domestic violence order (protection order). NB: A respondent is the person against whom the domestic violence order is made.

Having a history does not necessarily preclude you being assessed as suitable. Applicants will be given an opportunity to discuss any history.

Complete All Sections Below:Please tick one

Have you had any involvement with the Department of Communities, Child Safety and Disability Services (formerly Department of Communities) or any Interstate/International Child Protection Agencies?

Do you have any traffic history information in Queensland, interstate or internationally?

Have you ever been the respondent (see Guidelines for definition) in a domestic and family violence matter in Queensland, interstate or internationally?

For Nominees and Directors –Email completed LCS Form – 2 and Blue Card Form (marked “confidential”) to CS_Licensing@communities.qld.gov.au or Post to Child Safety Licensing, Department of Communities, Child Safety and Disability Services, GPO Box 806, Brisbane, Qld, 4001, or Fax to 07 3898 0135.

For Service Managers/other persons engaged by the service – Email completed LCS Form – 2 to csces_csu_process@communities.qld.gov.au or Post to Central Screening Unit, Department of Communities, Child Safety and Disability Services, PO Box 13126, George Street, Brisbane, Qld, 4003 or Fax to 07 3239 3580

Child Protection Regulation 2011 – Part 7 Suitable Person

Child Protection Act 1999 – Schedule 3, definition “suitable person”

17. A person is a suitable person for having the custody or guardianship of a child if the person –

(a) does not pose a risk to the child’s safety, and

(b) is able and willing to care for the child in a way that meets the standards of care in the statement of standards; and

(d) understands, and is committed to, the principles for administering the Act (see s 5, Principles for administering the Child Protection Act 1999)

Note: Under Section 61 (Types of Child Protection Orders) of the Act, the Children’s Court may make an order granting custody or guardianship of a child.

18. A person is a suitable person for managing a licensed care service if the person –

(a) does not pose a risk to the safety of children to whom, under the Act, the licensee is providing care services ; and

(b) is able and willing to manage the licensed care service in a way that –

(i) assists the licensee to ensure the provision of care complies with the statement of standards; and

(ii) implements the methods mentioned in Section 126(f), of the Act; and

19. A person is a suitable person to be a director of an applicant for a licence, or a licensee for a licensed care service if the person –

(a) does not pose a risk to the safety of children to whom, under the Act, the licensee is providing care services; and

(b) is able and willing to manage the licensed care service, or ensure the licensed care service is managed, in a way that ensures the provision of care complies with the statement of standards; and

20. A person is a suitable person to be a nominee for a licence if the person –

(a) does not pose a risk to the safety of children who, under the Act, are in the care of the licensee; and

(b) is able and willing to fulfil the responsibilities of a Nominee for a licence under Section 130(1) of the Act

21. A person is a suitable person to be engaged in relation to the provision of care services by a licensed care service if the person does not pose a risk to the safety of children in the custody or guardianship of the Chief Executive. 22. A person is a suitable person to be an approved foster carer of any child if the person –

(a) does not pose a risk to the child’s safety; and

(b) is able and willing to protect the child from harm; and

(d) has completed any training reasonable required by the Chief Executive to ensure the person is able to care properly for a child

23. A person is a suitable person to be an approved kinship carer of a child if the person –

(a) does not pose a risk to the child’s safety; and

(b) is able and willing to protect the child from harm; and

(d) has completed any training reasonable required by the Chief Executive to ensure the person is able to care properly for a child.

24. A person is a suitable person to be a provisionally approved carer of a child if the person –

(a) does not pose a risk to the child’s safety; and

(b) is able and willing to protect the child from harm

25. A person is a suitable person for associating on a daily basis with children or a particular child if the person does not pose a risk to the children’s or child’s safety.

26. In deciding if a person is a suitable person under this Part, the Chief Executive or a Court may consider the following:

(a) the person’s employment history;

(b) the person’s physical or mental health;

Message

Part 1: Organisation Information

Part 2: Applicant Information

Personal Details

Part 3: Address History in the Last 5 Years

Part 4: Privacy and Consent

Privacy Notice:

Guidelines

Applicant to read and sign consent.

Part 5: Proof of Identity

Part 6: Identification Documents Sighted and Verified

Part 7: Personal History Check of Applicant

Guidelines

Complete All Sections Below:Please tick one

Child Protection Regulation 2011 – Part 7 Suitable Person