Application for a Certificate of Approval

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1 Private Security Personnel Licensing Authority For more information visit Application for a Certificate of Approval Under the Private Security Personnel and Private Investigators Act What is this form used for? Use this form to apply for a certificate of approval to enable you to work for a licence holder in the private security industry or as a crowd controller (also known as a bouncer or doorman). You can apply for a certificate in one of seven categories. These categories are listed in Section 1. 2 What do you need to complete your application? To complete your application you need to send: A fully completed form A passport style photo (for more information see overleaf) A cheque for $200 (or $220 if you are also applying for a temporary certificate) 3 Completing this form Print clearly in CAPITALS. Use a black or blue pen to complete this form. Answer every question on the form unless the instructions tell you otherwise. 4 Payment Information The fee for filing an application for a Certificate of approval is $200 Temporary certificate of approval is an additional $20 You can only pay by cheque. Make your cheque payable to: The Private Security Personnel Licensing Authority. For a quicker, easier, cheaper way of applying apply online see Application fees are non-refundable. 5 How long will it take to hear the outcome of your application? In normal circumstances it will take a month to hear the outcome of your application. If you have a criminal conviction your application may take longer to process. You can check the progress of your application on 6 Important information If you: Provide false or misleading information to the Licensing Authority, you may be liable for a fine of up to $20,000. Work for a licensee or as a Crowd Controller without holding a Certificate of Approval you could be fined up to $20,000. All personal information provided to the PSPLA will be managed in accordance with the Privacy Act Page 1 For more information visit PSPLA 02/15 - A

2 Photograph Requirements Any photograph of an individual submitted to the Licensing Authority in non-electronic form for the purpose of sections 24, 46, or 111 must: (a) be of good quality; and (b) have been taken not more than 6 months before the date on which it is supplied; and (c) be a full front view of the face, head and shoulders of the person, with the head filling most of the photograph; and (d) have a plain, light coloured background (not white or dark) with no background shadow; and (e) show the individual without a head covering, hat, head band, bandanna or scarf except for religious or medical reasons. In all cases, facial features from the bottom of the chin to the top of the forehead and both edges of the face must be clearly shown; and (f) be a colour photograph; and (g) be a good likeness of the person; and (h) be 45mm high x 35mm wide; and (i) be on good quality paper. Attach photo here 45mm high x 35mm wide Section 1 - Application Details What class or classes of work are you applying for: (you may tick Private investigator employee Confidential document destruction agent employee Security technician employee Personal guard employee more than one) Security consultant employee Property guard employee Crowd controller employee Repossession agent employee te: crowd controllers and private investigators have special responsibilities. For more information go to Have you undertaken the relevant training requirements namely NQA unit standard 27360, NQA unit standard and NQA unit standard 27364? Please note that some people are exempt from the requirement to hold NQA unit standard See here for more details (Please tick to confirm ) you are required to attach a copy of your training certification to this application. you must undertake the required training. However you can apply for a temporary certificate of approval to allow you to work while you complete the training. A temporary certificate is valid for three months. The following permit classes Private Investigator, Security Technician and Security Consultant are of a specialised nature and you must provide suitable evidence that you are: competent or trained receiving appropriate training The evidence of competency for Private Investigator, Security Technician and Security Consultant can be: letter from previous/current employer as to work history letter from previous/current employer that you are an apprentice qualifications gained member of the N Institute of Professional Investigators (NIPI) If you need to work for a licence holder or as a crowd controller employee whilst your application is being processed, you may be eligible for a temporary certificate of approval. Do you wish to apply for a temporary certificate of approval (Please tick to confirm ) Please note a temporary certificate of approval is an additional $20.00 (in addition to your application fee). If you have previously held a licence or a certificate of approval under the Private Investigators and Security Guards Act 1974 or the Private Security Personnel and Private Investigators Act 2010, provide your licence number or certificate number here: Page 2 For more information visit PSPLA 02/15 - A

3 Section 2 Personal Details What is your name? First name(s) Middle name(s) Last name(s) Are you known by, or have you ever been known by another name? (Please tick to confirm ) If yes please supply details, if no leave this box blank and move on to the next question. Other name 1 First name(s) Middle name(s) Last name(s) Other name 2 First name(s) Middle name(s) Last name(s) Date of Birth / / (day / month / year) What is your gender? (Please tick to confirm ) Male Female Are you currently employed? (Please tick to confirm ) If yes, please supply further details below, if no please move to the residential address question. What is your occupation? Who are you employed by? If you are employed by several employers please list their names here Page 3 For more information visit PSPLA 02/15 - A

4 Section 2 Personal Details (contd) What is your residential address? Street Suburb Postcode City / town State (if outside of N) Country Do you have a different postal address? (Please tick to confirm ) If yes what is your postal address: Street / PO Box Suburb Postcode City / town State (if outside of N) Country How can we contact you? Daytime contact number ( ) Other contact number ( ) Mobile number Fax number ( ) address Section 3 Photo Identification Details Photo identification is required to verify your identity when you pick up your Certificate of Approval and ID badge. Please provide details of your Passport, New ealand Driver s Licence, HAN 18+ card or New ealand Firearms Licence below: or Passport number Nationality as shown on passport Passport expiry date / / (day / month / year) Date issued / / (day / month / year) New ealand Driver s Licence number Driver s Licence expiry date / / (day / month / year) Driver s Licence version number or Other identification type HAN 18+ N Firearms licence Other identification number Page 4 For more information visit PSPLA 02/15 - A

5 Section 4 Disqualification Criteria You are not eligible to hold a certificate of approval if disqualification criteria apply to you. Section 62 of the Private Security Personnel and Private Investigators Act 2010 lists certain grounds that may disqualify you from being granted a certificate of approval. If you meet any of the grounds of disqualification listed below, you will be able to make a statement about your character, circumstances or background. The Licensing Authority may still grant your application, but only if the Authority is satisfied that you are suitable to work in the class or classes of work to which the application relates. Please note that no refund is payable if your application is unsuccessful. You can find more information at Please answer each individual question below. (Please tick to confirm ) Have you ever been convicted of a specified offence as defined in section 4 of the Criminal Records (Clean Slate) Act 2004? In the last 7 years, have you been convicted by a New ealand court of an offence under the Arms Act 1983? In the last 7 years, have you been convicted by a New ealand court of an offence under sections 216H to 216J of the Crimes Act 1961? In the last 7 years, have you ever been convicted by a New ealand court of an offence under sections 10, 11, 13, 16, 19, 21, 24, 47F, or 47J of the Fair Trading Act 1986? In the last 7 years, have you ever been convicted by a New ealand court of an offence under section 103(1) of the Credit Contracts and Consumer Finance Act 2003 that involves a breach of any provision of Part 3A of that Act? In the last 7 years, have you ever been convicted by a New ealand court of an offence under section 8 or 25 of the Harassment Act 1997? In the last 7 years, have you ever been convicted by a New ealand court of an offence under section 6 of the Misuse of Drugs Act 1975 in relation to quantities deemed for supply of a Class A, B or C controlled drug or drugs? In the last 7 years, have you ever been convicted by a New ealand court of an offence of dishonesty, as defined in section 4 of the Private Security Personnel and Private Investigators Act 2010 ( offence of dishonesty )? In the last 7 years, have you ever been convicted by a New ealand court of an offence of violence, as defined in section 4 of the Private Security Personnel and Private Investigators Act 2010 ( offence of violence )? In the last 7 years, have you ever been convicted by a New ealand court of an offence under sections 16, 34 or 52 of the Private Investigators and Security Guards Act 1974? Have you ever been disqualified from driving for an indefinite period and ordered to attend an assessment centre under section 65 of the Land Transport Act 1998, or an earlier equivalent provision? Have you ever been ordered by a New ealand court to be imprisoned following conviction for an offence and that conviction or order has not been quashed on appeal? In the last 7 years, have you ever been convicted by a New ealand court of an offence under the Private Security Personnel and Private Investigators Act 2010 or Private Investigators and Security Guards Act 1974 for working without a licence or certificate or approval or employing or engaging a person without a certificate of approval? In the last 7 years, have you had a licence or certificate of approval cancelled under the Private Security Personnel and Private Investigators Act 2010 or the Private Investigators and Security Guards Act 1974? Do you hold a licence or certificate of approval that has been suspended? Page 5 For more information visit PSPLA 02/15 - A

6 Section 4 Disqualification Criteria (contd) Have you ever had an order made in relation to you under section 34(1)(b) of the Criminal Procedure (Mentally Impaired Persons) Act 2003, section 118 of the Criminal Justice Act 1985, or section 39J of the Criminal Justice Act 1954 (being an order imposed, instead of passing sentence, that you be treated or cared for in a manner that your mental impairment requires, either in your own interest, or the safety of the public, or for the safety of the public, or for the safety or a person or class of person)? Are you currently subject to a court order that requires you to be detained in a hospital because of a mental condition? If you have answered yes to a ground for disqualification you can provide further information to support your application (for example, evidence of your character, circumstances, or background). If you need extra space please attach a separate sheet to this application. Have you met any requirements prescribed in regulations made under section 114(h)(i) of the Private Security Personnel and Private Investigators Act 2010, (which relate to the competency, knowledge, and skills required for licences and certificates of approval)? [You must provide proof of meeting those requirements with this application.] If you have completed any of the training requirements set out in section 114(1)(h) of the Private Security Personnel and Private Investigators Act 2010, please provide details below: If you need extra space please attach a separate sheet to this application. Section 5 Overseas Mental Health Orders and Convictions Section 46 of the Private Security Personnel and Private Investigators Act 2010 also requires that you specify if you have had an overseas mental health order or conviction. You may provide further information to support your application (for example, information about your character, circumstances, or background) if you have specified a conviction or order as follows: (Please tick to confirm ) Have you ever had an order imposed in relation to you by any court or tribunal outside of New ealand, instead of passing sentence, that you be treated or cared for in relation to your mental impairment? Have you ever been convicted of an offence outside of New ealand? Page 6 For more information visit PSPLA 02/15 - A

7 Section 5 Overseas Mental Health Orders and Convictions (contd) Please provide further information below: If you need extra space please attach a separate sheet to this application. Section 6 Certificate and Badge Collection Which branch of N Post would you prefer to pick up your certificate of approval and ID badge from (should your application be successful?) a list of branches can be found at Location Section 7 Consent and Certification I consent to the Ministry of Justice undertaking a criminal history check using the information contained in my application. I certify that the above particulars are true and correct. Name Date / / (day / month / year) Signature Section 8 Checklist Before you submit this form please check that: (Please tick to confirm ) You have answered every applicable question; You have attached your photograph; You have signed and dated this form; and You have included a cheque totalling the amount of the application. Please mail this completed form with photograph and cheque to: Private Security Personnel Licensing Authority DX Box: SX Wellington Page 7 For more information visit PSPLA 02/15 - A

8 Legislative Extract - Definitions of Certificate of Approval classes of business Meaning of private investigator employee In this Act, private investigator employee means an individual who in the course of his or her employment, or engagement as a contractor, by a private investigator seeks, or obtains for any person or supplies to any person, any information specified in section 5(2). Meaning of security technician employee In this Act, security technician employee means an individual who in the course of his or her employment, or engagement as a contractor, by a security technician (a) installs or repairs on, or removes from, any part of any premises that are not owned or occupied by the security technician, the security technician s firm, or any of the security technician s partners (i) a burglar alarm or similar warning device intended to immediately alert a person or persons to the presence of a person or persons in a particular place; or (ii) a locking device for a safe or a strongroom; or (b) installs, operates, causes to be operated, or repairs, on or in, or removes from, any premises or other place not owned or occupied by the security technician, the security technician s firm, or any of the security technician s partners any camera or similar device for the purpose of detecting the commission of any offence by any person. Meaning of security consultant employee In this Act, security consultant employee means an individual who in the course of his or her employment, or engagement as a contractor, by a security consultant (a) enters any premises that are not owned or occupied by the security consultant, the security consultant s firm, or any of the security consultant s partners for the purpose of selling or attempting to sell any device of the kind referred to in section 6(1)(a) or (b); or (b) enters any premises that are not owned or occupied by the security consultant, the security consultant s firm, or any of the security consultant s partners for the purpose of advising the owner or occupier of the premises on the desirability of having installed on the premises any, or any further, such device; or (c) enters any premises that are not owned or occupied by the security consultant, the security consultant s firm, or any of the security consultant s partners for the purpose of advising the owner or occupier of the premises on the desirability of having guarded the premises or any other property that may from time to time be on the premises or dispatched from the premises. Meaning of repossession agent employee In this Act, repossession employee (a) means an individual who in the course of his or her employment, or engagement as a contractor, by a repossession agent or a creditor repossesses, or holds himself or herself out as being authorised to repossess, consumer goods; and (b) includes a creditor who carries out a repossession himself or herself, regardless of whether the creditor is, in fact, an employee. Meaning of confidential document destruction agent employee In this Act, confidential document destruction agent employee means an individual who in the course of his or her employment, or engagement as a contractor, by a confidential document destruction agent (a) collects, for destruction, documents identified as being of a confidential nature; and (b) destroys those documents. Meaning of property guard employee In this Act, property guard employee means an individual who in the course of his or her employment, or engagement as a contractor, by a property guard (a) guards, elsewhere than on premises owned or occupied by the property guard, the property guard s firm, or any of the property guard s partners, any real or personal property belonging to another person; or (b) monitors in real time, elsewhere than on premises owned or occupied by the property guard, the property guard s firm, or any of the property guard s partners, any of the following: (i) a burglar alarm or similar warning device intended to immediately alert a person or persons to the presence of a person or persons in a particular place: (ii) a camera or similar device; or (c) responds to any device in paragraph (b)(i) or (ii) that has been activated and that is on any part of any premises that are not owned or occupied by the property guard, the property guard s firm, or any of the property guard s partners. Meaning of personal guard employee In this Act, personal guard employee means an individual who in the course of his or her employment, or engagement as a contractor, by a personal guard (a) guards a specific person or persons; or (b) guards a specific person or persons and keeps order at any place (not being premises or a conveyance licensed under the Sale of Liquor Act 1989) where the person or persons being guarded may be. Meaning of crowd controller employee (1) In this Act, crowd controller employee means an individual who in the course of his or her employment, or engagement as a contractor, by a crowd controller or other person (a) screens entry to a place (other than simply ensuring that admission has been paid or that those entering have appropriate invitations or passes): (b) keeps order in a place (more than merely being expected to draw the attention of others to behaviour that is inappropriate or threatens to become inappropriate): (c) removes any person from a place. (2) A person is not a crowd controller employee if (a) he or she is not employed or engaged primarily to do work of a kind specified in subsection (1)(a), (b), or (c), but performs that work incidentally to the principal work he or she performs; or (b) he or she does the work specified in section 18(b) and no other work of a kind specified in subsection (1)(a), (b), or (c). Page 8 For more information visit PSPLA 02/15 - A

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