Request & Consent Form
Section 3: Applicant to complete and return to Approved Agency
Consent to release information
1. The New Zealand Police may release any information they hold if relevant to the purpose of this vetting request.
• Conviction histories and infringement/demerit reports
• Active charges and warrants to arrest
• Charges that did not result in a conviction including those that were acquitted, discharged without conviction,
diverted or withdrawn
• Any interaction I have had with New Zealand Police considered relevant to the role being vetted, including
investigations that did not result in prosecution
• Information regarding family violence where I was the victim, offender or witness to an incident or offence,
primarily in cases where the role being vetted takes place in a home environment where exposure to physical
or verbal violence could place vulnerable persons at emotional or physical risk.
• Information subject to name suppression where that information is necessary to the purpose of the vet
2. If I am eligible under the Criminal Records (Clean Slate) Act 2004, my conviction history will not be released unless:
a. Section 19(3) of the Clean Slate Act applies to this request (exceptions to the clean slate regime)
b. Section 31(3) of the Vulnerable Children Act 2014 applies to this request (safety checks of core children’s
c. The vetting request is made by an individual for the purpose of an overseas Visa/Work Permit as a Privacy Act
request authorising the vetting result to be provided directly to the relevant embassy, high commission or
Please see the guide
for more information regarding the Clean Slate legislation.
3. The Police Vetting Service may disclose newly-obtained relevant information to the Approved Agency after the
completion of the Police Vet in the following circumstances:
• The disclosure of the newly-obtained information is considered to be justified under the Privacy Act 1993 (if it
had existed or been available at the time of the Police vet, it would have been disclosed); and
• The Police Vetting Service has taken steps to confirm that the purpose of the Police vet still exists – e.g. that I
got the role which required a Police vet and am still employed or engaged in it.
The Vetting Service will endeavour to notify you prior to the disclosure.
4. Information provided in this consent form may be used to update New Zealand Police records.
5. I am entitled to a copy of the vetting result released to the Approved Agency (to be provided by the agency) and can
seek a correction by contacting the Vetting Service.
6. The Approved Agency will securely dispose of this consent form, copies of identification documents and the vetting
result within 12 months of receiving the result unless a longer retention period is required by legislation.
7. I may withdraw this consent, prior to Police’s disclosure of the vetting result, by notifying the Approved Agency.
For further information, please see the Guide to Completing the Consent Form
I confirm that the information I have provided in this form relates to me and is correct.
I have read and understood the information above.
I authorise New Zealand Police to disclose any personal information it considers relevant to my application (as
described above) to the Approved Agency making this request for the purpose of assessing my suitability at any time.
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