Version: 2Effective Date: April 2021
CAUTION
It is an offence to knowingly provide false information to the Civil Aviation Authority or Director of Civil Aviation relevant to the
Authority’s or the Director’s exercise of powers under the Civil Aviation Act, or regulations or rules made under the Act. It is also an
offence to fail to disclose, without reasonable excuse, information that is materially relevant in relation to a security check.
Each offence is punishable by a term of imprisonment not exceeding 12 months or a ne not exceeding $10,000.
Section 49(1)(a) and Section 56A, Civil Aviation Act 1990.
Airport Identity Card
Consent Form
AVSEC 3.7
YOUR INFORMATION (must be completed by the applicant in block capitals)
First Name:
Middle Name(s):
Current Surname / Family Name:
Other names you are known by or have used previously:
First Middle Surname
First Middle Surname
NZ Contact Phone: Email:
Gender : (please tick) Date of Birth: (DD/MM/YYYY)
M
F
Home Address:
City/Town: Postcode:
Previous Addresses: (only ll out if you have lived at the above address less than 5 years)
Country of Citizenship: Town/City of Birth:
Country of Birth: Job title:
NZ Driver Licence No. Version No. Employer:
NON NEW ZEALAND CITIZENS: (Please provide a copy of your visa.)
Residency Status: (tick as appropriate)
Permanent Residency No./Work Visa No./Student Visa No. Expiry Date: (DD/MM/YYYY)
Passport No. Issuing Country of Passport:
Expiry Date: (DD/MM/YYYY)
Permanent Resident Work Visa Student Visa
Version: 2Effective Date: April 2021
YOUR INFORMATION CONTINUED (to be completed by applicant)
consent to the Aviation Security Service, as an authorised delegate of the
Director of Civil Aviation, carrying out a security check on me;
understand that in giving consent for a security check that I am (1)
authorising the collection of information about me, and (2) authorising
any person or organisation contacted to disclose information about me
to the Aviation Security Service;
consent to the information supplied in making this application being
used for security purposes;
consent to the Aviation Security Service, on behalf of the Director of Civil
Aviation, informing my employer/sponsor about the result of the security
check performed on me. The advice to my employer will be limited to
conrming whether a favourable, adverse or proposed adverse security
check determination has been made, but not the reason for, or details of,
any determination;
agree to notify the Aviation Security Service immediately if I am
convicted of an offence prior to the expiry of my airport identity card;
note that information obtained for the purposes of the security check will
be handled according to the principles of the Privacy Act 2020;
note that under the Privacy Act 2020 I have the right to request access
to, or correction of, any personal information held by the Aviation Security
Service.
I have read and understood the above information relating to my
application for an airport identity card.
(full name of applicant)
I,
DO I HAVE TO AGREE TO A SECURITY CHECK?
You must consent to the Aviation Security Service carrying out a
security (background) check on you to determine whether you pose a
threat to aviation security. If you refuse to consent to a security check,
your application for an airport identity card will not be considered.
In carrying out a security check, we ask people or organisations
to disclose information about you. For example we can seek: a
recommendation from the New Zealand Security Intelligence Service,
information about your criminal record (if any) from the Ministry of
Justice, or information from the New Zealand Customs Service or the
New Zealand Immigration Service.
You and your employer will be informed whether you have received a
favourable security check determination or an adverse security check
determination. Advice to your employer will not include the reason for,
or details of, any determination.
Favourable security check determination
You need to receive a favourable security check determination in order
to be granted a permanent airport identity card.
Adverse security check determination
In the case of an adverse security check determination, you have the
right to have the determination reviewed under section 77G of the
Civil Aviation Act 1990. However, if your objection is based solely on a
recommendation from the New Zealand Security Intelligence Service,
you must follow a complaint process with the Inspector-General of
Intelligence and Security under the Intelligence and Security Act 2017.
If new information comes to light at any time, we can reconsider a
favourable security check determination and revoke your airport
identity card. In this case, you should refer to section 77F of the Civil
Aviation Act 1990.
WHAT HAPPENS TO MY PERSONAL INFORMATION?
Information contained in this application will be kept in the strictest
condence and handled according to the principles of the Privacy
Act 2020. Under the Privacy Act you have the right to request access
to, or correction of, any personal information held by the Aviation
Security Service.
Today’s Date: (DD/MM/YYYY)
Applicant’s Signature: