QP 0349B Application for a Police Certificate Name with Fingerprint Search Page 1 of 2
QP 0349B
Please ensure your Application is fully completed and legible. Failure to supply the requested information
may mean that the QPS is unable to process this form. For ENQUIRIES contact a Client Liaison Officer by
email: pic.certificates@police.qld.gov.au or phone: (07) 3364 6262.
A Police Certificate based on Australia–wide check of criminal history records using name with fingerprint search.
NOTE: Police Certificates are usually for EMPLOYMENT or OVERSEAS TRAVEL purposes.
Proof of identity—Please ensure a copy of ONE of the following forms of identification is attached to this application:
1. Your current driver licence
Number: Issuing state:
Your current passport
including photograph and signature Number: Issuing country:
Two other forms of i
dentification bearing your signature
Documents produced:
The fingerprints you provide will be compared against the national fingerprint system administered by the CrimTrac Agency—
an Executive Agency of the Commonwealth. This search is part of the nation–wide check of criminal history records.
The Queensland Police Service usually registers fingerprint images on the national fingerprint system together with the applicant’s
name, date of birth and gen
der. Registered fingerprint images and personal details remain as a permanent record on the system.
All Australian police services have access to the system for the performance of their policing functions.
The Queensland Police Service will only permanently register your fingerprint images and de
tails if you consent.
(It is MANDATORY to tick one box.)
I do not consent to my fingerprint images and details being permanently registered on the national fingerprint system
and require them to be destroyed after comparison.
I consent to my fingerprint images and details being permanently registered.
Applicant details
Family name: Given name(s):
Other names you have been known by:
(such as name at birth, alias(es), previous married name(s))
Date of birth:
/ /
(DD / MM / YY)
Male Female
Place of birth: Town: State: Country:
Queensland personal
mailing address:
Daytime contact:
If the Certificate is for overseas travel (visa) purposes, AND IF IT IS REQUIRED TO BE FORWARDED DIRECTLY to the
Consulate of the country to which you are travelling, state FULL name and address of Consulate:
In consideration of the issue and supply of the document requested herein, I hereby undertake and declare that I will not take any action
either civil or criminal against the Commissioner of the Queensland Police Service or Police Service of any other State or Territory of
the Commonwealth of Australia, or of any other country, or authorise or cause or procure or permit any person on my behalf to take
any action concerning anything had or done by them in relation to this application.
Date: DD / MM / YY
(DD / MM / YY)
(Applicant signature)
(Witness signature) (Witness name)
QP 0349B Application for a Police Certificate Name with Fingerprint Search Page 2 of 2
Police use only: (Ensure application is fully completed and legible)
Name of applicant:
Fingerprints must be taken by a police officer and the original QPRIME fingerprint form attached. Attached
Copy of Proof of Identity must be attached to this form. Attached
Fee paid: $ Receipt no.: Police Station:
Send completed application and attachment(s) IMMEDIATELY and DIRECTLY to: Police Information Centre, GPO BOX 1440, BRISBANE Qld 4001.
Privacy Collection Statement
The Queensland Police Service (QPS) is collecting your information for the processing of your application for a Police Certificate. The collection of this information is authorised by the
Police Service Administration Act 1990 (Qld). The information on this form will not be used or disclosed without your consent unless such use or disclosure is authorised or required by law,
including the Police Service Administration Act 1990 (Qld) and the Information Privacy Act 2009 (Qld). You have a right to access personal information that QPS holds about you, subject
to any exceptions in relevant legislation. If you wish to seek access to your personal information or inquire about the handling of your personal information, please contact Right to
Information and Privacy by email at rti@police.qld.gov.au.