Last updated January 2020 Please check the ACECQA website to ensure that you are using the current version
Provisional Skills Assessment
Applicant Declaration and Consent Form
Applicant declaration and consent
Please tick each clause below and sign the declaration in the presence of the witness. The witness must be a person
authorised to legally witness or certify documents.
I, (the applicant) declare that:
I understand that providing false or misleading information is an offence and all the information I have
provided is true and correct. If an authorised representative has assisted me, I declare I have not
provided false or misleading information to the representative for preparation of this application.
I have read and understood ACECQA’s Provisional Skills Assessment Application Guidelines.
I authorise ACECQA to make enquiries to third parties in order to verify and assess my qualifications.
I understand that my assessment will take up to 60 calendar days from the date I provide all the
information required by ACECQA.
I understand that if additional information is requested and is not provided within the requested
timeframe, ACECQA may close my application and I will not be entitled to a refund.
If I have provided anyone else’s personal information, I confirm that it is with their consent.
I will inform ACECQA of any changes to my circumstances (e.g. change of contact details) while my
application is being processed.
I have read and understood ACECQA’s privacy policy.
Day Month Year
Signature of Date
applicant
Day Month Year
Signature of Date
authorised
witness
Authorised witness name
(Printed)
Authorised witness occupation
or JP number
/ /
/ /
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