Gaming Industry Employee’s Licence
Application Form for a New Licence and Information Pages
Send application to:
Employee Licensing Unit
Victorian Commission for Gambling Regulation
PO Box 1988
MELBOURNE VIC 3001
Or lodge in person at:
Level 5, 35 Spring Street
MELBOURNE VIC 3000
For enquiries contact:
Victorian Commission for Gambling Regulation
Office Hours: 9am to 5pm, Monday to Friday
Telephone: (03) 9651 3054
Email: [email protected]
Internet: www.vcgr.vic.gov.au
Application for a Gaming Industry Employee’s Licence
Contents
IMPORTANT INFORMATION
Directions for Completion ..............................................................................................................................................
False or Misleading Information ....................................................................................................................................
Publication of Disciplinary Action ..................................................................................................................................
Privacy Policy ................................................................................................................................................................
Confidentiality Provisions ...............................................................................................................................................
2
2
2
2
2
LODGEMENT GUIDE..................................................................................................................................................... 3
APPLICATION FORM
Payment Details ............................................................................................................................................................. 4
Personal Particulars ................................................................................................................................................. 5 - 6
Gaming History ........................................................................................................................................................ 6 - 7
Other Regulatory History ............................................................................................................................................... 7
Legal Action ................................................................................................................................................................... 8
Charges, Findings of Guilt and Convictions .................................................................................................................. 9
Financial Particulars ............................................................................................................................................. 10 - 11
Declaration by Applicant .............................................................................................................................................. 11
‘Financial Information Release’ Form .......................................................................................................................... 12
‘Consent for Release of Information by Law Enforcement Agencies’ Form ................................................................ 13
INFORMATION PAGES
Who should complete this application form? ...............................................................................................................
What are the duties of a gaming industry employee? ................................................................................................
How can the application form be lodged? ...................................................................................................................
What happens after the application form is lodged? ...................................................................................................
Is finger and palm printing required? ..........................................................................................................................
What happens if there is a change to personal particulars after submission of this form? ..........................................
What happens after a licence is granted? ..................................................................................................................
Is training required? .....................................................................................................................................................
14
14
14
14
14
15
15
15
ATTACHMENTS
Checklist for Fingerprinting an Applicant .................................................................................................... Attachment 1
National Police Certificate .......................................................................................................................... Attachment 2
Credit Report .............................................................................................................................................. Attachment 3
ATTACHMENTS TO THE QUESTIONS
1
Application for a Gaming Industry Employee’s Licence
IMPORTANT INFORMATION
Directions for Completion
•
•
•
Answer all relevant questions (if a mandatory question is not answered you will be prompted when you save
and will not be able to complete the application until all mandatory questions are answered).
If the space available is insufficient, please supply the required information by selecting the EDIT button below
the question and typing the additional data in the text box provided.
The application form will not be accepted if you don't provide a response to all applicable questions or if all
required attachments are not enclosed.
If you are completing a hard copy of this application form, you must:
•
Answer every Question.
•
If a question does not apply, or if there are no details to disclose in response to a particular question, print “N/
A” (not applicable) in response.
•
If the space available is insufficient, please supply the required information on an attachment page. Begin each
answer with the title and reference of that question.
•
This application form will be returned if any Question is not answered or if all required items listed below are not
attached prior to lodging the application.
NOTE: Only persons over 18 years of age can apply for a licence.
False or Misleading Information
It is an offence under the Gambling Regulation Act 2003 to give information that is false or misleading. If you give false
or misleading information, your application may be refused and/or you may be prosecuted and fined up to 60 penalty
units (go to www.vcgr.vic.gov.au/ScheduleofFeesandFines.pdf for the current value of a penalty unit).
Note: A licence that is improperly obtained by giving false or misleading information may be cancelled. In addition, under
provisions of the Evidence Act 1958, if you make a false declaration you are liable to the penalties for perjury under
the Crimes Act 1958.
Publication of Disciplinary Action
A bingo centre operator licence holder may be subject to disciplinary action being taken by the VCGR. If the VCGR
does take disciplinary action against a licensed bingo centre operator, its decision, including the licensee's full name and
licence number, will be published on the VCGR website and in the VCGR Annual Report.
Privacy Policy
Personal information supplied by the applicant is collected, used and stored in accordance with the Information Privacy
Act 2000. In accordance with the VCGR’s privacy policy and relevant laws, you may be able to gain access to any
personal or health information held about you by the VCGR. A full copy of the VCGR’s privacy policy can be obtained
from the VCGR website, or you can ask that a copy of the relevant privacy policy be sent to you by contacting the Privacy
Project Manager on (03) 9651 3333 or by email at [email protected].
Confidentiality Provisions
Information provided in your application must not be disclosed by the VCGR or its staff to someone else, except for
the purposes stated in Division 6 of Chapter 10 of the Act. You may view these provisions via the VCGR’s website at
www.vcgr.vic.gov.au by clicking the ‘Legislation Administered’ option under the ‘Legislation and Standards’ button.
2
LODGEMENT GUIDE
Application for a Gaming Industry Employee’s Licence
STEP 1:
Metropolitan Applicants:
If you live within 50kms of the Melbourne CBD and have not been previously fingerprinted in relation to a
VCGR application*, you must attend the VCGR, fifth floor, 35 Spring Street, Melbourne for fingerprinting
between the hours of 9.00am and 5.00pm Monday - Friday. No appointment is necessary.
Apply for your National Police Certificate (Name Check and Fingerprint Records Search) and/or an equivalent
report from the relevant Police Agency –Refer to Attachment 2 and Page 9.
Regional Applicants:
If you live outside 50kms of the Melbourne CBD and have not been previously fingerprinted in relation
to a VCGR application*, you must attend a regional police station for fingerprinting. By going to https://
www.police.vic.gov.au/content.asp?Document_ID=695 and then choosing the “Download Livescan
Locations” button you can determine which station is convenient. If there are no stations listed in your vicinity,
contact the Employee Licensing Unit on 9651 3054 or at [email protected] to make alternative
arrangements.
If attending a regional police station for fingerprinting, the signed checklist for fingerprinting regional
applicants must be attached to your application form–Refer to Attachment 1.
Apply for your National Police Certificate (Name Check and Fingerprint Records Search) and/or an equivalent
report from the relevant Police Agency –Refer to Attachment 2 and Page 9.
STEP 2:
Apply for your Credit Report and/or an equivalent report from the relevant overseas agency –Refer to
Attachment 3 and Page 11.
STEP 3:
Obtain 2 Colour Passport Photos (with your name printed on the back of each photo).
STEP 4:
When you have received your National Police Certificate and Credit Report you may:
Complete the application form (Note: Answer all questions and ensure that all names included in the
application form match those in your NPC and Credit Report).
Print and sign the form where required.
Attach your National Police Certificate, Credit Report, photos and any other required documents.
Lodge form with VCGR, together with the correct application fee (to confirm the current application fee go to
www.vcgr.vic.gov.au/ScheduleofFeesandFines.pdf) The application fee may be paid by cheque, money
order, credit card or if attending the VCGR by Eftpos or cash (Note: Under no circumstances should cash be
sent through the mail and if paying by cash ensure that you have the correct amount as there is no facility to
provide change).
* If you have been previously fingerprinted in relation to a VCGR application, you must contact the Employee
Licensing Unit on (03) 9651 3054 or at [email protected] to confirm that fingerprinting will not be required.
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Amount Received $ ...................................................................
Application for a
Gaming Industry
Employee's
Licence
Receipt No. ................................................................................
Signature ....................................................................................
Date: ........../........../..............
Application No. ...........................................................................
Assigned to (Print name) ...........................................................
Payment Details
IMPORTANT INFORMATION
The prescribed fee must accompany an application for a gaming industry employee’s licence. Please note that once the
receipt of an application has been registered, the application fee is non-refundable .
Refer to the Schedule of Fees and Fines on the VCGR’s website to confirm the current fee for a new gaming industry
employee’s licence.
Please tick the box below to indicate your method of payment and, if paying by credit card, complete the “PAYMENT
BY CREDIT CARD” section:
cheque or money order, made payable to the Victorian Commission for Gambling Regulation;
cash or Eftpos payment at the VCGR’s office at Level 5/35 Spring Street, Melbourne. If paying by cash,
please ensure that you have the correct amount as there is no facility to provide change (DO NOT under any
circumstances send cash through the mail); or
credit card (Visa or MasterCard) by completing the appropriate details on the form.
PAYMENT BY CREDIT CARD
Card Type :
Master Card
Visa
Card Number :
Expiry Date:
Amount:
/
$
Name Shown on Card
Cardholder’s Signature
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Personal Particulars
IMPORTANT INFORMATION
When applying for your National Police Certificate and your Credit Report you must ensure that you
provide:
* your first name, middle name/s, surname [as stated in Q1(a)];
* as well as, where applicable, any preferred given name to appear on your licence [as stated in Q1(b)];
and
* any alias(es), previous names, maiden name, name changes (legal or otherwise) as well as names you
have used or by which you have been known [as stated in Q1(c) & (d)].
If all such names are not shown in your NPC and Credit Report, your application will not be accepted.
1.(a)
Mr
Mrs
Miss
Ms
Male
Female
Full name:
First Name
Date of Birth:
/
Middle Name(s)
/
Arrival date in Australia (if applicable):
Surname
Place of Birth:
/
/
/
(b) Preferred given name to appear on licence:
Note: If granted, your preferred given name will appear on the front of the licence and your full name
will be printed on the back of the licence.
(c) Are you currently known or have you previously been known by another name(s), including any
alias(es), Anglicised name(s), maiden name, married name(s) and name(s) changed via deed poll?
Yes
No
If YES, list other name/s:
(d) Have you had any legal name changes?
Yes
No
If NO, proceed to Q2. If YES, provide additional details below:
Name Changed From
Name Changed To
Have further details been provided on an attachment page?
Date of Change
Yes
/
/
/
/
No
2. Current residential address:
No.
Street
City/Town/Suburb
State
5
Postcode
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3. Postal address (if same as Q2, tick ‘as above’)
as above
No.
Street
City/Town/Suburb
State
Postcode
4. Contact details:
Email Address:
Telephone (BH):
Telephone (AH):
Mobile Phone:
Facsimile:
5. PHOTOGRAPHS:
Securely attach 2 colour passport size photographs taken within the last 3 months to
this application. Do not cut or separate passport photographs. Ensure your name is
clearly printed on the back of each photograph. It is recommended that you provide
your photographs in a sealed envelope with your name clearly printed on the front of
the envelope. Securely attach the envelope to this page.
Attach colour passport
photographs here
Complete the following:
(a) I have attached 2 passport size photographs:
(b) Date photographs taken (day/month/year):
YES
/
/
Gaming History
6. Have you ever applied, whether in Victoria or elsewhere, for any casino industry or gaming industry
licence, approval, authorisation or registration?
Yes
No
If NO, proceed to Q8. If YES, provide the following details for each application and then proceed to Q7.
(a) If the application was granted/approved or is still pending, provide details below:
Type of licence, approval, etc
Licence No (if known)
Jurisdiction
Name shown on licence, approval etc
Name of Gaming Regulator (if known) :
Licence/Approval Association dates:
/
to
/
(b) If the application was refused or withdrawn, provide details below:
Type of licence, approval, etc
Date of applcation (mm/yyyy):
Jurisdiction
/
Reason for refusal or withdrawal:
Have further details been provided on an attachment page?
6
Yes
No
7. Have you ever had any casino industry or gaming industry licence, approval, authorisation or
registration, whether in Victoria or elsewhere, suspended, cancelled, amended or revoked, or been the
subject of disciplinary action by a regulatory body? ( Note: Include details of any special conditions or
restrictions imposed on a licence, concession etc)
Yes
No
If NO, proceed to Q8. If YES, provide the following details:
Type of licence, approval, etc
Licence No (if known)
Jurisdiction
Name of Gambling/Racing Regulator (if known)
Details of action taken or any special conditions or restrictions imposed on a licence, approval etc:
Have further details been provided on an attachment page?
Yes
No
8. Have you ever been employed by the Victorian Commission for Gambling Regulation or its
predecessors?
Yes
No
If NO, proceed to Q9. If YES, provide details below:
Position Held:
Date finished (mth/yr):
/
9. Have you ever been excluded from a casino either in Australia or overseas (List of excluded persons,
book of cheats, Black Book - USA etc)?
Yes
No
If NO, proceed to Q10. If YES, provide details on an attachment page.
Have further details been provided on an attachment page?
Yes
No
Other Regulatory History
10. Have you ever had any other (non gambling) licence, approval, authorisation or registration, whether
in Victoria or elsewhere, suspended, cancelled, amended or revoked, or been the subject of disciplinary
action by a regulatory body? (Note: Exclude your driver licence and motor vehicle registration and include
details of any special conditions or restrictions imposed on a licence, approval etc)
Yes
No
If NO, proceed to Q11. If YES, provide the details below:
Type of licence, approval, etc
Licence No (if known)
Name of Gambling/Racing Regulator (if known)
Jurisdiction
Details of action taken or any special conditions or restrictions imposed on a licence, approval etc:
Have further details been provided on an attachment page?
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Yes
No
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Legal Action
IMPORTANT INFORMATION
Note: A business association includes cases where you are or were a director or office holder of a company
or partner in a partnership at the time the legal action was taken against the company or partnership.
11. During the last 10 years, have you been, either personally or via a business association, a defendant
or respondent in any finalised legal action?
Yes
No
If NO, proceed to Q12. If YES, provide the following details:
The legal action was (tick appropriate box):
personal
via business association
Nature of legal action:
Plaintiff:
Jurisdiction:
Result/Settlement:
Court or tribunal where matter was heard (if applicable):
Case no issued by court/tribunal:
Date of delivery of judgement:
/
/
If arising via a business association, describe how your responsibilities or actions related to the legal
action:
If a matter has been finalised a copy of independent documentation confirming the court outcome or, if
settled out of court, a copy of the settlement agreement must be provided, regardless of whether any
terms of the agreement are confidential. Is a copy of the court outcome or settlement agreement attached?
Yes
No
Have further details been provided on an attachment page?
Yes
No
12. Is there any legal action currently being pursued against you, whether personally or via a business
association?
Yes
No
If NO, proceed to Q13. If YES, provide the following details for each action:
The legal action was (tick appropriate box):
personal
via business association
Nature of legal action:
Plaintiff:
Jurisdiction:
Court or tribunal where matter is scheduled to be heard:
(if known)
Case no. issued by court/tribunal:
Next scheduled hearing date:
/
/
If arising via a business association, describe how your responsibilities or actions related to the legal
action:
Have further details been provided on an attachment page?
8
Yes
No
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Charges, Findings of Guilt and Convictions
IMPORTANT INFORMATION
If you currently live in Australia or if you have lived in Australia for at least 12 months during the last 10 years
this form must be accompanied by your original National Police Certificate (NPC) obtained by you from
Victoria Police (refer to instructions at Attachment 2).
Your NPC must be obtained not more than 3 months before this form is lodged and you must ensure that all
names noted in Q1(a)-(d) are advised to the Victoria Police when applying for your NPC. If all such names
are not shown in your NPC, your application will not be accepted. To confirm the fee for your NPC, go to
www.vcgr.vic.gov.au/FeeforNameCheck&FingerprintSearch .
You must disclose details at Q14 of any offence not included in your NPC, including participation
in a Diversion Program, spent convictions, findings of guilt, suspended sentences, matters where
a good behaviour bond is given and/or matters where no conviction is recorded, other court orders
and provide details of all outstanding charges. Failure to disclose such matters may affect your
application. However, Children’s Court matters more than 10 years old and non-custodial traffic
matters, which are those for which a penalty other than a jail sentence or community based order
was given, are not matters which you are required to disclose at Q14.
If you do not currently live in Australia and you have not lived in Australia for at least 12 months during
the last 10 years, to assist the VCGR with its investigations you are requested to seek an equivalent report
from your local Police Agency. An equivalent report would be expected to reveal details in relation to any
convictions, findings of guilt (either with or without conviction) and any matters still outstanding against you.
13. (a) Do you currently live in Australia or have you lived in Australia for at least 12 months during the
last 10 years?
Yes
No
If YES to Q13(a), an NPC must be provided.
(b) Do you currently live outside Australia or have you lived outside Australia for more than 12 months
during the last 10 years?
Yes
No
If YES to Q13(b), an equivalent report from the relevant Police Agency must be provided and if an equivalent
report is not enclosed, provide an explanation on an attachment page.
14. Other than already disclosed in your NPC or equivalent report from your local Police Agency:
(a) Have you ever been found guilty of any offence?
Yes
No
(b) Is there any investigation or charge currently pending against you in respect of any offence?
Yes
No
(c) Have you ever participated in a Diversion Program?
Yes
No
If NO to Q14(a), (b) or (c) proceed to Q15. If YES to either Q14(a), (b) or (c), provide details below in
relation to each matter:
Nature of offence:
Date:
/
/
Jurisdiction*:
Result:
Result of Hearing or other Disposition (if known)
Have further details been provided on an attachment page?
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Yes
No
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Financial Particulars
15. (a) Have you ever been bankrupt, subject to an arrangement under the Bankruptcy Act (eg. Part X) or
subject to any like proceedings?
Yes
No
If NO , proceed to Q15(b). If YES, complete the following and provide details of circumstances leading to
Bankruptcy/Arrangement proceedings on an attachment page.
Date of Bankruptcy/Arrangement:
/
Date of Discharge/Completion:
/
/
/
Note: If you are a discharged bankrupt, a copy of your Certificate of Discharge From Bankruptcy must
accompany this application (Do not send the original certificate). Is a copy enclosed?
Yes
Name of Trustee:
Address:
No.
Street
City/Town/Suburb
State
Postcode
Telephone Number
(b) Are bankruptcy or any like proceedings pending, in any jurisdiction*?
Yes
No
If YES, provide details of circumstances leading to these proceedings on an attachment page.
Have further details been provided on an attachment page?
Yes
No
16. Are you currently or have you been a director or officer of a company or incorporated association,
whether in Victoria or elsewhere:
(a) which has been wound up, placed into liquidation (except members’ voluntary liquidation), had
a receiver or other controller or administrator appointed, entered into a formal or informal scheme of
arrangement (however it is described) or has been subject to any like proceedings?
Yes
No
(b) where an investigation into the affairs of the company/incorporated association has been authorised by
the Australian Securities and Investments Commission or its predecessors under Corporations Law, by the
Registrar of Incorporated Associations under the Associations Incorporation Act 1981, by the Australian
Prudential Regulation Authority, by the Australian Competition and Consumer Commission exercising their
statutory functions or by any other regulatory body or law enforcement agency?
Yes
No
If NO to Q16(a), (b) and (c), proceed to Q17. If YES to Q16(a), (b) or (c) complete the following for
each matter and provide details of circumstances leading to proceedings on an attachment page:
Company Name:
Type of proceedings:
Commencement Date:
/
/
Details of trustee, administrator, liquidator, receiver/manager, regulatory body or law enforcement agency:
Name:
Phone no:
Have further details been provided on an attachment page?
10
Yes
No
17. Have you ever been disqualified from acting as a director or company secretary of a company or are
any like proceedings pending, in any jurisdiction*?
Yes
No
If NO, proceed to Q18. If YES, complete the following:
Date of disqualification:
/
/
Jurisdiction*:
Have further details been provided on an attachment page?
Yes
No
IMPORTANT INFORMATION
You must obtain an original Credit Report if:
· you currently live in Australia; or
· you do not currently live in Australia but have lived in Australia at any time during the last 10 years; or
· you are or have been during the last ten years a director of officeholder of an Australian company.
The Credit Report you obtain cannot be more than 3 months old when you lodge this application.
If your circumstances do not meet the criteria noted above, a Credit Report is not required. Note: If you live
or have lived outside Australia or have lived outside Australia for at least 12 months during the last 10 years
you are requested to submit an equivalent report from the relevant agency in that jurisdiction*.
You must ensure that all names noted in Q1(a) - (d) are advised when applying for your Credit Report. If
any such names are not shown in your Credit Report, your application will not be accepted. Instructions on
obtaining your Credit Report are provided at Attachment 3.
18. Have you enclosed your original Personal Credit Report or an equivalent report from the relevant
agency in your jurisdiction?
Yes
No
If YES, proceed to Q19. If NO, provide reasons why a Credit Report or an equivalent report from the
relevant overseas agency has not been enclosed on an attachment page.
Have further details been provided on an attachment page?
Yes
No
19. Apart from matters recorded in your Personal Credit Report or any equivalent report from an agency
in your jurisdiction, are you currently in default of any debt incurred solely or jointly in your name? ( Note:
Do not include details unless a payment is overdue or in arrears)
Yes
No
If NO, proceed to Statutory Declaration. If YES, complete the following:
Financial Institution or creditor
Total amount
owing
Total amount
in default
$
$
$
$
$
$
$
$
Have further details been provided on an attachment page?
No of days
payment is overdue
Yes
No
Declaration
I declare that I have read and understood the questions in this application form and the directions for
answering them and I have answered the questions truthfully and completely to the best of my knowledge.
Signed:
Date:
/
/
(Day/Month/Year)
Signature of witness *:
Print name of witness *:
* Any adult can be a witness
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VICTORIA
Gambling Regulation Act 2003
Financial Information Release Form
In the matter of this application for a gaming industry employee’s licence by:
Name :
of
(Print Applicant’s name)
Address :
('applicant')
(Full address of Applicant)
The applicant hereby authorises all persons who receive a photocopy of this release form from the Victorian
Commission for Gambling Regulation (the VCGR) and its staff to undertake the authorised actions for the authorised
purposes as set out below:
Authorised actions
1.
To allow the VCGR to inspect and obtain a copy of any document, record or correspondence in the possession
or under the control of the person, which contains information pertaining to the Applicant (or to the Applicant and
another person and to any subsidiary, related body corporate, trust or partnership to which the Applicant was a
party), including but not limited to any loan information;
any information relating to an account held with a financial institution (passbook, statement or other),
including information relating to withdrawals, deposits, transfers and balances;
any information (including trust account information) of any solicitor, accountant, real estate agent or other
fiduciary.
2.
To answer written or verbal queries of, and to provide information (by any means) to the VCGR to undertake the
authorised actions, about the financial resources of the applicant.
Release
In consideration of a bank, other financial institution, solicitor, accountant, financial adviser or any other person or
organisation who has lent money to or borrowed from the applicant providing any of those particulars recorded against
the applicant as detailed above under the heading “Authorised actions”, I hereby release the VCGR to the full extent
of the law and against any claim or demands of any kind and any actions, suits, proceedings, claims, demands, costs
and expenses whatsoever which may be taken or made in respect of the use or misuse of the information obtained out
of this authorisation.
Authorised purposes
To enable the VCGR to make an assessment of the Applicant’s financial stability and that, in conducting on-going
monitoring, an Applicant’s continuing financial stability. This consent commences on the date below and continues
until the later of:* the VCGR considers that I am no longer a gaming industry employee; or
* the expiry of any gaming industry employee’s licence (if granted).
Signed:
Dated:
Applicant’s signature
/
/
(Day/Month/Year)
NOTES
1. A photocopy of this form will be considered as effective and as valid as the original.
2. A reference in this financial information release form to the VCGR includes a reference to a member of its staff
and any other person appointed in writing by the VCGR.
12
VICTORIA
Gambling Regulation Act 2003
Consent for Release of Information by Law Enforcement Agencies
In the matter of this application for a gaming industry employee’s licence and for the purposes of ongoing monitoring
by:
Name :
(Full name of applicant)
Address :
('Applicant')
(Full address of applicant)
CONSENT
The Applicant hereby consents to all probity investigations carried out by the Victorian Commission for Gambling
Regulation (the VCGR) and its staff, including but not limited to:
(a)
*
*
*
*
Inspection of criminal, intelligence or other records kept or maintained by:
the Victoria Police;
* any State, Territory, federal or overseas police force;
any crime investigation agency;
* any corporate regulatory agency;
any gambling regulatory body;
* any casino regulatory body.
any Court;
* any government agency.
(collectively referred to as 'law enforcement agencies')
(b)
Release of particulars of any convictions, findings of guilt or other information recorded against me by the law
enforcement agencies including, without limitation:
*
*
*
*
details of all prosecutions, including acquittals and matters withdrawn or dismissed and all findings of guilt,
whether or not a conviction was recorded;
matters or charges still outstanding;
law enforcement agencies intelligence howsoever obtained;
any other matters recorded as arising either in Victoria or elsewhere by any law enforcement agency and
considered relevant by the VCGR to the investigation or assessment of my application for a gaming industry
employee’s licence under the Gambling Regulation Act 2003.
RELEASE
Upon signing this consent, the Applicant hereby releases the VCGR, each law enforcement agency and their servants,
agents or contractors to the full extent of the law and against any claim or demands of any kind and any actions, suits,
proceedings, claims, demands, costs and expenses whatsoever which may be taken or made in respect of the use or
misuse of the information obtained out of this consent, including particulars of any conviction, findings of guilt or other
adverse material purporting to relate to the Corporation.
ACKNOWLEDGEMENT
I acknowledge having read and understood the terms of the consent and the release and have noted that independent
legal advice may be sought before signing this consent. This authorisation commences on the date below and
continues until the later of:* the VCGR considers that I am no longer the holder of a gaming industry employee’s licence; or
* the expiry of any gaming industry employee’s licence (if granted).
A photocopy of this form will be considered as effective and as valid as the original
EXECUTION AS A DEED
Dated:
Signature of Applicant
/
/
(Day/Month/Year)
Signature of Witness
Printed Name of Witness (any adult can be a witness)
13
Information Pages
Who should complete this application form?
You are required to obtain a gaming industry employee’s
licence if you will perform any of the duties of a gaming
industry employee as prescribed in the Gambling
Regulation Regulations 2005.
B) Functions of a gaming industry employee in a
bingo centre:
The prescribed functions of a gaming industry employee
in a bingo centre are -
What are the duties of a gaming industry employee?
A) Duties of a gaming industry employee working for
a venue operator or a gaming operator:
The prescribed duties of a gaming industry employee
employed by or working for a venue operator or a gaming
operator are -
(b) writing up running sheets;
(a) to investigate gaming machine irregularities and
disputes players have about a gaming machine and
report them to the gaming operator;
C) Other duties of a gaming industry employee:
Other prescribed duties of a gaming industry employee
are -
(a) selling bingo tickets;
(c) checking back numbers on bingo tickets;
(d) paying prizes;
(e) supervising persons performing any of the functions
referred to in paragraphs (a) to (d).
(b) to validate a win by a player on a gaming machine;
(a) to install gaming equipment;
(c) to pay prizes and refunds;
(b) to connect gaming equipment to an electronic
monitoring system at the premises of a gaming
operator or at an approved venue;
(d) to provide gaming tokens to players, redeem
gaming tokens for players and physically or
electronically store gaming tokens;
(c) to supervise persons carrying out any of the duties
referred to in paragraphs (a) and (b)
(e) to possess and issue gaming equipment keys
to other persons holding a gaming industry
employee’s licence;
(f)
How can the application form be lodged?
Your completed application form (including all
attachments) can be submitted by post or lodged in
person at the VCGR’s office.
to access the locked area of a gaming machine;
(g) to maintain accounts and perform reconciliations in
relation to returns and payments required under the
Gambling Regulation Act 2003 (the Act);
What happens after the application form is lodged?
Upon receiving your licence application form, the form
will be reviewed to ensure that all questions have been
completed and that all required attachments have been
included. An application found to be incomplete in any
way will be returned to you along with the application fee
and/or credit card payment authority.
(h) to secure data within gaming equipment relating
to games and gaming, the electronic monitoring
system and player accounts;
(i)
in relation to gaming equipment software a. to program the software;
b. to prepare, collate and access documentation
in realtion to the software;
Is finger and palm printing required?
Unless you have been previously fingerprinted in relation
to a VCGR application, you must consent to having your
finger and palm prints taken and referred to the Victoria
Police. If you have been previously fingerprinted, you
need to contact the Employee Licensing Unit on (03)
9651 3054 or at [email protected] to
confirm that fingerprinting will not be required.
c. to secure the software;
(j)
to transfer gaming equipment software into
operational mode;
(k) to vary a gaming machine or game in accordance
with an approval given under section 3.5.5 of the
Act;
(l)
In order to establish your identity, original and current
forms of identification must be produced at the time
of fingerprinting. You must supply a minimum of two
types of identification with a minimum total of 100
points (refer to Attachment 1 for details of appropriate
identification) and must include at least one type of
photo ID (Category A) plus identification that contains
your current residential address, signature and date
of birth. Documents not in the English language must
be translated and certified by an accredited translation
service.
to manually activate or re-activate a gaming
machine or game approved under section 3.5.4 of
the Act.
(m) to supervise persons carrying out any of the duties
referred to in paragraphs (a) to (l).
14
Information Pages
If you wish to obtain a Full Birth Certificate you should
contact the Registry of Births, Deaths and Marriages
on 1300 369 367, or, in person, at Ground Floor, 595
Collins Street, Melbourne (Postal Address PO Box 4332,
Melbourne 3001). To order a certificate via the internet
go to www.online.justice.vic.gov.au .
What happens if there is a change to personal
particulars after submission of this form?
If there is any change to any of the information provided
in your application form (between lodgement and a
decision being made about your application) you must
notify the VCGR in writing within 14 days of the change
taking place. Failure to provide the VCGR with updated
information may result in your application being refused
or may result in disciplinary action being taken against
you and/or a fine of up to 60 penalty units.
Metropolitan Applicants
If you live within 50kms of the Melbourne CBD, you must
attend the VCGR, fifth floor, 35 Spring Street, Melbourne
for fingerprinting between the hours of 9.00am and
5.00pm Monday - Friday. No appointment is necessary.
What happens after a licence is granted?
Your licence, which is valid for a period of ten years, will
be mailed to your nominated postal address. If you wish
to make alternative arrangements, such as the personal
collection of the licence, contact the Employee Licensing
Unit on (03) 9651 3054.
Regional Applicants
If you live outside 50 kms of the Melbourne
CBD you may attend a regional police station for
fingerprinting. No appointment is necessary. You must
produce appropriate identification as noted above. Your
fingerprints will be sent directly by the officer to the
Victoria Police Fingerprint Branch and you will receive
back the signed checklist which you must attach to your
application form.
Please note that a licence is subject to conditions giving
you an ongoing responsibility to notify the VCGR of
specified changes in your situation. This responsibility
will continue even if you cease employment in the
gaming industry, unless and until your licence expires, is
cancelled or is formally surrendered by you to the VCGR.
Failure to notify the VCGR of any specified change may
result in disciplinary action being taken against you and/
or a fine of up to 60 penalty units.
Is training required?
A gaming industry employee employed by a venue
operator is required to complete:
15
•
an approved training course within the first six
months after starting employment; and
•
an approved refresher course at least once every
three years following completion of the approved
training course.
Attachment 1
VICTORIA POLICE
CHECKLIST FOR FINGERPRINTING A NOMINEE
REGIONAL APPLICANTS ONLY
Note:
(1) When completed and signed, the applicant must return this checklist to the VCGR along with their application
form.
(2) Only applicants living outside 50 kms of the Melbourne CBD may use this form. All other applicants are
required to have their fingerprints taken at the VCGR situated at Lvl 5/35 Spring St, Melbourne.
1. Applicants must supply at least two types of ID with a minimum total of 100 points (see overleaf).
Form of identification:
Form of identification:
Form of identification:
Points:
Points:
Points:
2. If applicants fingerprints and palm prints are taken using Livescan:
•
•
•
•
use Civil mode when using Livescan, select either “Gaming Applicant” or “Casino Applicant” as the relevant
record type and in the “Remarks” section note the relevant reason (e.g. applying for a gaming industry
employee’s licence);
the Member must complete Section A (Victoria Police Use Only section) in the ‘Consent to Check and Release
National Police Record’ form;
complete the Statement below; and
then return checklist to applicant.
3. If applicants fingerprints and palm prints are taken using VP Form 235 or 236:
•
•
•
•
•
•
applicant and Member to complete personal details on fingerprint form;
Member to endorse on rear of form with either “Gaming Applicant” or “Casino Applicant” and note the relevant
reason (e.g. applying for a gaming industry employee’s licence);
the Member must complete Section A (Victoria Police Use Only section) in the ‘Consent to Check and Release
National Police Record’ form;
follow steps 4-7 below;
complete the Statement below; and
then return checklist to applicant.
4. If applicants fingerprints and palm prints are taken using VP Form 235 or 236:
VicPol Fingerprint Branch
DX 210071
5. Place sealed envelope in internal DX mail
Statement for Completion by Member taking Prints
Fingerprints of
(applicant’s name),
being an applicant for approval as an associate of a registered bookmaker, were taken by
(name, rank and registered number of member)
at
Police Station.
Contact Phone No:
/
Signature
/
Date
Proof of Identity
Proof of Identity Documentation
Applicants must supply a minimum of two types of identification from the list below with a minimum total of 100 points.
Identification must include at least one type of photo ID (Category A) plus identification that contains the applicant’s
current residential address, signature and date of birth.
Category A (at least one Category A document must be provided)
Current Passport
Driver licence/Learner’s permit/boat licence
Firearms/Private security licence
Current tertiary student ID card (with photo)
WWC Check card/Keypass/Proof of age card
Certified current passport size photo (if the applicant
does not possess any other Category A ID)
Points
70
40
40
40
40
40
Category B
Australian citizenship certificate
Birth certificate (not extract)
Birth card
Australian travel documents or current Australian Visa
Department of Veterans Affairs (DVA) card
Centrelink card (with reference number)
Government employee ID
70
70
70
70
40
40
40
Category C
Medicare Card
Credit card of Account card
Marriage certificate (registry issue only)
Change of name certificate (registry issue only)
Bank statement (with residential address)
Motor vehicle registration or insurance papers
Property rates notice/utilities notice
Property lease agreement
Home insurance papers
Taxation assessment notice
Records of primary, secondary or tertiary education
Records from a current or previous employer
Records of a professional or trade association
25
25
25
25
25
25
25
25
25
25
25
25
25
Attachment 2
NATIONAL POLICE CERTIFICATE
If you live in Australia or have lived in Australia for at least 12 months during the last 10 years, an original National
Police Certificate (NPC) must be provided when you lodge your VCGR application form. Your NPC is obtained by
submitting a ‘Consent to Check and Release National Police Record’ form (Consent form) to the Victoria Police.
You may download the Consent form, which includes instructions for completion, at: www.vcgr.vic.gov.au/
VictoriaPoliceConsentform . If you have any difficulties in accessing the Consent form contact the Employee
Licensing Unit at [email protected] or on (03) 9651 3054.
NPC Application Fee
You must choose the “National Name Check” NPC option. You can confirm the fee for this type of NPC at
www.vcgr.vic.gov.au/FeeforNameCheck&FingerprintSearch .
NPC Application Process
Should you have any other questions in relation to your police record check you may contact the Public Enquiry Service
of Victoria Police on 1300 881 596 between 8am and 5pm. Please inform the customer service officer that you are a
VCGR applicant.
Please note that:
•
•
•
•
a 100 point identity check is incorporated into the consent form;
for metropolitan applicants, VCGR staff will witness and certify identity documents and signature in relation to
the Consent form and will also take the fingerprints using Livescan;
for country applicants, Victoria Police staff at police stations with a Livescan finger and palm printing facility will
witness and certify identity documents and signature in relation to the Consent form, take the fingerprints using
Livescan and complete the Checklist Attachment Page regarding fingerprinting in this application; and
the completed Consent form, together with the certified documents and fee (cheque or money order only,
payable to Victoria Police) must then be posted to Public Enquiry Service of Victoria Police for processing.
Note: The term “Livescan” refers to the new and preferred method of electronic fingerprinting.
In addition, when you apply to the Victoria Police for your NPC you must ensure that in the Consent form you:
•
•
•
•
choose the “Name Check and Fingerprint Records Search” option in Section A (unless you have been advised
otherwise by the Commercial Licensing and Monitoring Unit);
provide your first name, middle name/s, surname [as stated in the Personal Particulars section of your VCGR
application form];
provide any preferred given name to appear on your licence [as stated in the Personal Particulars section of your
VCGR application form]; and
provide any alias(es), previous names, maiden name, name changes (legal or otherwise) as well as names
you have used or by which you have been known [as stated in the Personal Particulars section of your VCGR
application form].
Note: If any such names are not shown in your NPC, your VCGR application form will not be accepted and you will
need to apply for a new NPC. Also, the NPC must be current at the time of lodgement of your VCGR application form
and not exceed three (3) months from the date of issue by the Victoria Police. If you do not provide your NPC, or
enclose either a photocopied NPC or an NPC more than 3 months from the date of issue, your VCGR application form
will be considered incomplete and will be returned to you. A minimum of ten working days should be allowed from the
date applications are received at the Public Enquiry Service for applications to be processed.
All matters detailed on your NPC are taken into consideration by the VCGR and are essential to allow assessment of your
character, honesty and integrity. Should you wish to dispute any of the information disclosed in your NPC you should do
so prior to lodging your VCGR application form, by writing to The Manager, Public Enquiry Service, Records Services
Division, Victoria Police, PO Box 418, Melbourne Victoria 8005.
Attachment 3
CREDIT REPORT
You must obtain an original Credit Report if you currently live in Australia, or if you have lived in Australia for at least
12 months during the last 10 years or if you are or have been a director or company secretary of an Australian company
during the last 10 years. ( Note: If your circumstances do not meet these criteria, a Credit Report is not required).
You may obtain a copy of your Credit Report from either Dun & Bradstreet Australia (D&B) or Veda Advantage (Veda).
These companies offer a number of services to monitor and manage your credit profile and adhere to the Privacy Act,
Credit Reporting Code of Conduct and the National Privacy Principles by providing you with the right to obtain a copy
of your Credit Report.
HOW TO OBTAIN YOUR CREDIT REPORT
DUN & BRADSTREET AUSTRALIA
D&B offers two timescales for delivery. The ‘Standard Service’ allows for your Credit Report to be supplied to you free
of charge in 10 business days. This report may be received via mail, or via an online account created specifically for
you. The ‘Instant Access’ service allows you to view your report within 24 hours online or have it delivered by Express
post (refer to D&B website for current fee).
The D&B ‘My Credit Report’ form can be completed online at www.dnbcreditreport.com.au (secure site)
or alternatively, you may contact D&B on 13 23 33 ( +61 3 9828 3333 for international callers) or at
[email protected] to arrange for provision of your Credit Report. D&B’s ‘Frequently Asked Questions’ may be
viewed at www.dnbcreditreport.com.au/faqs/ .
VEDA ADVANTAGE
To obtain your Credit Report from Veda, you must submit the ‘My Credit File – Request by Gaming or Racing Applicant’
form by post, fax or email, as addressed on the form (refer to the form for current fee). The Credit Report will be forwarded
within one business day. This form may be downloaded from the VCGR website at www.vcgr.vic.gov.au/vedaform or
alternatively, you may contact Veda on 1300 921 621 to arrange for its provision. Additional information may be viewed
at www.vedaadvantage.com/personal/mcf/my-credit-file.dot
IMPORTANT INFORMATION REGARDING YOUR CREDIT REPORT
When requesting a copy of your Credit Report, you are required to provide the following details:
* Family Name, First Name, Middle Name, Salutation [as stated in the Personal Particulars section of your VCGR
application form];
* any preferred given name [as stated in the Personal Particulars section of your VCGR application form];
* Any other name(s) you have used - List any other name(s) by which you are currently known or were known
previously, such as alias(es), anglicised name(s), maiden name, married name(s) and name(s) changed via deed
poll [as stated in the Personal Particulars section of your VCGR application form]; and
* Current and Previous Residential Address Date of Birth and Driver Licence Number (if available).
Your Credit Report and any other letter from the Credit Report provider advising of the result of the search conducted
must accompany your VCGR application form. If you fail to meet any of the requirements noted below, your VCGR
application form will be considered incomplete and returned to you. Your Credit Report must:
* be original and not a photocopy;
* be current at the time of lodgement of your VCGR application form, i.e. lodged within three months from its date of
issue;
* include your current name and any other name(s) that you are currently or were previously known by, such as any
preferred given name, alias(es), anglicised name, maiden name, name(s) changed via deed poll; and
* correctly disclose your other personal details, i.e. date of birth, address and driver licence number (if available).
If you find any issues with your Credit Report, e.g. it is incomplete or you wish to dispute any of the information disclosed
therein, you should contact the Credit Report provider (see contact details above) and resolve the issue/s prior to lodging
your VCGR application form.
ATTACHMENTS TO THE QUESTIONS