PSD0001 Consent to Obtain Personal Information ... - Health Sciences

PSD0001Vacancy details: DCS Business Area, Contract Manager or panel chairperson to complete this section.DCS position no: DCS position title: Level:DCS division:DCS directorate:Has applicant had a break in service of 3 months or more? (Please circle)Yes No New DCS applicantRFT no:Service provider role: (External applicants only, please also Include DCS position and division)Agency name:Verification of applicant identification: DCS and service providersIdentification verified (please consult applicant Identification Guide) It is a contractual obligation that ID is verified and listed:Verified by: (Print Name)Position title:List ID checked, include document numbers: (form will be returned if not complete) Do not make copiesService providers please note:When completed, submit this form to the relevant section within the Department of Corrective Services (DCS) towhom you provide the service, or to the Contract Manager. Give the applicant the information page and Identification Guide to keep Send only the 2 pages of the form, fully completed, to DCS Do not take or make copies of an applicants identification documents Do not send consent forms direct to the screening officeIncomplete forms will not be processed.DCS Business Area or Contract Manager to complete this sectionForm checked by: (Print name) Position title:Signature:DCS contact person for notification:Date:D D / M M / Y Y Y YDCS email address for contact:DCS business area/contract manager please note:Once received, check the information is complete, fill in the section above and submit this form to the Screening Office. Send only the 2 pages of the form, fully completed, to the Screening Office.(not Recruitment and not Personnel Services)Facsimile: 08 9264 1764Scan and email:Internal mail:screening@correctiveservices.wa.gov.auLevel 8 Westralia SquareExternal mail: PO Box Z5124 Perth Adelaide Terrace WA 6831(Post Office preferred format)Incomplete forms will not be processed.Updated April 2010 Page 2 of 2