NSW Department of Education Logo Tertiary Practicum Student Application Form
Welcome Guest26-Jul-2021 02:57

Declaration for Child Related Work - Tertiary Practicum Students

This declaration must be completed by students undertaking unpaid tertiary practicum placement with the Department of Education (the Department) where the person is required to hold a NSW Working with Children Check clearance under the Child Protection (Working with Children) Regulation 2013. See the Department's Working with Children Check Procedure for more details.

Name Details
Name on NSW WWCC clearanceName TypeTitleFirst NameMiddle NameFamily Name

Please select the name that was used on your NSW WWCC Clearance from the above

Identity document: Upload Government-issued photo identity document with full name, date of birth and current residential address and, if relevant, change of name document. The Department may verify any document with the issuing authority. Click here for guide to Identity Documents


  • A digital driver's licence's is not acceptable for Working With Children Check verification purposes. Digital IDs are only acceptable for club entries or if you are presenting yourself in person for identity verification.
  • Uploading documents is a two-step process 1. Click on the 'Choose' button to select your document from a directory 2. Click on 'Upload' to attach the chosen document to your application.
  • You will be required to provide more than one identity document if you don't have a single document that contains all the required information stated above.
  • The maximum size of any document to be uploaded cannot exceed 20mb.

Choose/Upload proof of identity.
File Name
No records found.
  1. I have no criminal convictions in the past ten years. I understand that "conviction" is defined in the Criminal Records Act 1991 and includes a conviction, whether summary or on indictment for an offence, and includes a finding or order that an offence has been proved, or that a person is guilty of an offence, without proceeding to conviction.
  2. I am not subject to any pending court proceedings relating to a criminal matter in Australia or overseas.
  3. I have no convictions that cannot become spent within the meaning of the Criminal Records Act 1991 including but not limited to:
    1. convictions for which a prison sentence of more than six months has been imposed; or
    2. convictions of sexual offences.
I am aware that providing false or misleading information in this document may lead to the Department:
  • withdrawing any offer of engagement that it has made to me; or
  • terminating my engagement, or taking disciplinary action which may include my dismissal; and
  • considering any false or misleading information I provide, when considering any future applications by me for engagement.

Privacy Statement

The information collected on this declaration document and from identification documents you provide will be used by the Department to manage risk associated with its legal obligation to ensure the protection of children and young persons in its care and for purposes directly related to your engagement with the Department.

The Department will use this information to verify your identity and NSW Working With Children Check (WWCC) clearance and to check the Department's business systems, including eCPC and the database of persons not to be employed, to ensure that there is no barrier to engaging the person.

If you are cleared for engagement, this information will be entered onto the Department's eCPC and you will be allocated unique employee identification number.

All information you provide will be used, disclosed and stored consistent with the NSW privacy and other relevant law. The completed declaration form and a record of the eCPC check will be filed by the school/business area in secure storage for seven years from date of inactivity and then destroyed. You may request access to this information from the school or business centre at which it is held. The Department will not disclose the information to another agency or person unless required or authorised by law.

Identification documents are viewed to verify your identity and check details recorded on the declaration form and in eCPC. Any copy of these documents will be securely destroyed immediately after use.

Failure to provide information required to complete this declaration and identity check may result in declination of your request to work as a volunteer or contractor.