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ACT Government Baseline Clearance

Application for Entry Level Clearance The position that you now occupy has been identified as a Position of Trust (POT). As such, it is a

requirement of the ACT Government, that you undergo a security assessment at the BASELINE level. The

ACT Government undertakes internal staff vetting in accordance with Commonwealth standards however

the clearance granted is only applicable whilst employed by the ACT Government and at this stage is not

transferable externally. Before you are able to undergo your ACT Government Baseline assessment you must complete the ENTRY

LEVEL security clearance e-pack which will provide you the necessities to undertake work within the

parameters assigned. Should your position require a clearance of a higher level you will be notified by

the Shared Services ICT (SSICT) Security Team. A higher level clearance above ACT Government Baseline

(referred to as an NV1- National level Negative Vetting 1 clearance) will require application to the

Australian Government Security Vetting Agency (AGSVA) and require Australian citizenship.

If you have an existing Baseline clearance from a Commonwealth Government agency, then this AGSVA

clearance would require transfer to Chief Minister Treasury and Economic Development Directorate

(CMTEDD). As part of the monitoring and reviewing of a person’s clearance, a program known as

“Aftercare” is adopted to ensure that the clearance holder is still a fit and proper person to hold that level

of clearance. The transfer of the external agency clearance will be noted and added to the existing

aftercare program arrangements.

Please note that access to some CMTEDD premises and access to restricted sections of the IT network

may be withheld until SSICT Physical and Personnel Security Team has received your completed security

clearance paperwork and no residual security concerns remain.

All information provided by you is treated in the strictest of confidence, is used only for security

purposes, and is handled in accordance with the provisions of the Information Privacy Act (ACT) 2014

(IPA). In accordance with the IPA all personal information collected and /or stored must be voluntarily

provided by you. If you choose not to provide personal information when completing the required

documents this may prevent you from obtaining the required access to the ICT network and/or CMTEDD

premises. Your Personnel Security file remains the property of CMTEDD (ACT Government).

Your complete understanding of and satisfaction with the standard clearance assessment process is

important to us. Therefore, should you require more information or have difficulties with any aspect of

this process please do not hesitate to contact the SSICT Physical and Personnel Security Team on

02 6207 2038 or via email on SSProtectiveSecurity@act.gov.au

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Definitions Position of Trust (POT)

A position that has ongoing access to information or resources deemed SENSITIVE, or have

control over business systems containing Sensitive DLM information.

This may include other situations where a directorate might determine it needs a high level of

assurance of a person’s suitability to perform a particular role.

Aftercare

Although great emphasis is placed on the initial screen process, people's circumstances

change.This is why there is a requirement to ensure ongoing suitability of cleared individuals.

Any significant change in personal circumstance that may impact on their continuing suitability to

access security classified resources must be reported to SSICT Physical and Personnel Security

Team on 02 6207 2038 or via email on SSProtectiveSecurity@act.gov.au

More information regarding aftercare will be distributed once the ACT Government Baseline

Clearance process has been finalised.

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Information Fact Sheet - Security Clearance Statutory Forms –Official Secrecy, General Consent, Security Questionnaire, Background check and Agreement to comply. Before completing these forms please read each of them carefully. There are repercussions if you breach any of these undertakings and it is important that you understand your legal responsibilities. Official Secrecy The Official Secrecy Form seeks an acknowledgement from you that you must not disclose, publish or in any way communicate official information gained through the course of your employment with the ACT Government. It may be an offence to release, without authorisation any official ACT Government information. The penalty is up to 2 years imprisonment. General Consent This form is your consent for the Directorate or it’s outsourcers to make enquiries, undertake checks, collect or have access to relevant information from a variety of sources. Security Clearance Questionnaire Please note that answering, ’yes’, to any of the questions does not necessarily preclude you from obtaining a security clearance. Agreement to Comply This document requires your consent and relates to the compliance of the use of Government resources and the directions given to you by authorised security personnel and Shared Services staff. This protects against the misuse of government resources and the misuse of information whilst undertaking the duties in CMTEDD. Background Check The current ACT Government requirements for new employees occupying a POT include;

Declaration of address history for the preceding five years.

Declaration of overseas travel history for the preceding five years.

AFP Form All ACT Government Baseline security clearances require a police check (name check only). Please note that when you complete the Police check form, please use Code 19. If you are under 18 your General Consent form and AFP form must be signed by a parent or guardian. SUPPORTING DOCUMENTATION REQUIRED There is a requirement to provide a 100 point identity check. Please refer to Appendix A for more information Additional documentation may be requested if required. If you are unable to provide any of the supporting documentation please do not hesitate to contact the SSICT Physical and Personnel Security Team on 02 6207 2038 or via email on SSProtectiveSecurity@act.gov.au IMPORTANT: Do not send originals. Please supply certified true copies of your supporting documentation. Please refer to Appendix B – Guidelines for the certification of documents Certification of Documents True copies and passports - “I certify this to be a true copy of the original which I have sighted” Name of Person making the certification Date: 10/10/09 Qualification to Certify: e.g., APS officer for 5 years and over, etc. Photos “This is the likeness of ...., whom I have known for more than 12 months” Name of Person making the certification Date: SSICT Security will also require 2 colour copies of your security Photo pass.

Sensitive: Personal

(When completed)

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OFFICIAL SECRECY

Full name

I,

Full residential address

of

Understand that all official information that will, or has been acquired by me in the course of my employment

with the ACT Government, which it is my duty not to disclose, is not to be published or communicated to any

unauthorised person in any form, either during or after my service in or with the ACT Government.

Signature Date

Witness Signature Date

Witness Full Name

Witness Residential Address

Crimes Act 1900 (ACT)

Section 153 (1) & (2) Disclosure of information by public employees

1. A person who, being an officer of the Territory, publishes or communicates, except to some person to

whom he or she is authorised to publish or communicate it, any fact or document which comes to his or her

knowledge, or into his or her possession, by virtue of him or her being an officer of the Territory and which it is his

or her duty not to disclose, commits an offence.

2. A person who, having been an officer of the Territory, publishes or communicates, without lawful

authority, any fact or document which came to his or her knowledge, or into his or her possession, by virtue of the

person having been an officer of the Territory and which, at the time when he or she ceased to be an officer of the

Territory, it was his or her duty not to disclose, commits an offence.

Penalty: Imprisonment for 2 years

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(When completed)

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GENERAL CONSENT

Full name in block letters

I,

Full residential address in block letters

Of,

Acknowledge that I have read the Information Letter, which explains the need for me to undergo the security

assessment process in accordance with ACT Government policy. I acknowledge that this process requires the

ACT Government, Chief Minister Treasury and Economic Development Directorate (CMTEDD), to make various

enquiries/checks about me (including AFP). I consent to CMTEDD, having access to relevant information about

me that will assist to make decisions about my suitability for an ACT Government security clearance.

Signature Date

Witness Signature Date

Witness Full Name

Parent or Guardian

Signature

Parent or Guardian

Full Name

Signature Date

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(When completed)

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SECURITY CLEARANCE QUESTIONNAIRE

Please answer the following questions by ticking the response that applies to your personal circumstances. If you answer ‘yes’ to any question, please provide full details in the space provided and return with your recruitment package. If you would prefer to discuss the matter personally, please contact the SSICT Physical and Personnel Security Team on 02 6205 1415

Do you have any feelings of loyalty or allegiance to any country other than Australia? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever served in the Armed Forces of any country? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever been charged or convicted of any offence? (Include all minor traffic offences.) Yes No If you have answered, ‘Yes’ please supply comment below.

Do you have any pending civil or criminal court actions in Australia or internationally? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever engaged in any criminal or questionable activity which has not been detected by a law enforcement agency? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever been dismissed from employment or left employment because of a discipline or misconduct issue (including military if applicable)? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever been subject to any disciplinary or Code of Conduct investigation (including military if applicable)? Yes No If you have answered, ‘Yes’ please supply comment below.

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(When completed)

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Have you ever resigned from a position while under investigation for any Code of Conduct violation where that investigation was discontinued after your resignation? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever been accused of, disciplined or counselled because of inappropriate use of an Information Communication Technology (ICT) system? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever been disciplined, counselled or dismissed due to an inappropriate use of classified information. Yes No If you have answered, ‘Yes’ please supply comment below

Are you now or have you ever been employed or acted as a consultant for a foreign government, firm or agency? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever had any contact with people who you, or others believe are, or have been, involved in political or religious extremism? Yes No If you have answered, ‘Yes’ please supply comment below.

Has a credentialed mental health professional ever given an opinion that you have a condition that may indicate a defect in judgement, reliability or stability? Yes No If you have answered, ‘Yes’ please supply comment below.

Is there anything in your personal life that could cause you embarrassment or reflects badly on your character, loyalty or trustworthiness? Yes No If you have answered, ‘Yes’ please supply comment below.

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(When completed)

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Do you drink alcohol? (If ‘yes’ how often and how many standard drinks when you drink?) Yes No If you have answered, ‘Yes’ please supply comment below.

Do you gamble? (If ‘Yes’ how often and how much spent?) Yes No If you have answered, ‘Yes’ please supply comment below.

To the best of your knowledge, is there anything in your background, past or present that may make you vulnerable to coercion or duress, exploitation or blackmail? Yes No If you have answered, ‘Yes’ please supply comment below.

Have you ever been declared bankrupt? Yes No If you have answered, ‘Yes’ please supply comment below.

Do you wish to discuss any of the information you have provided on the questionnaire? Yes No If you have answered, ‘Yes’ please supply comment below.

Should background checking reveal that you have attempted to deliberately mislead the ACT Government and/or Chief Minister Treasury and Economic Development Directorate, it may cause delays to your commencement date or ultimately have a bearing on the granting of your security clearance. Please note that answering ‘yes’ to any of these questions does not necessarily preclude you from obtaining a security clearance. Each issue is assessed on its merits and is based on the circumstances, your attitude and community standards. I declare that the information provided on this form and any attachment is true and correct.

Full Name

Signature

Date

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(When completed)

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BACKGROUND CHECK

Residential History – Last 5 years Overseas Travel History – Last 5 Years

Address 1:

Country:

Dates:

Address 2:

Country:

Dates:

Address 3:

Country:

Dates:

Address 4:

Country:

Dates:

Address 6:

Country:

Dates:

Address 7:

Country:

Dates:

Address 8:

Country:

Dates:

Address 9:

Country:

Dates:

Should you require more writing room please use multiple forms or contact SSICT Physical and Personnel Security Team on 02 6205 1415. Should background checking reveal that you have attempted to deliberately mislead the ACT Government and/or Chief Minister Treasury and Economic Development Directorate, it may cause delays to your commencement date or ultimately have a bearing on the granting of your security clearance. Full Name

Signature Date

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(When completed)

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Agreement to Comply

I, _______________________________________________________________________ (Applicant)

Name in full

of ________________________________________________________________________________

Current residential address

Understand that the ACT Government requires all ACT Government Directorates to ensure that people who

are entrusted with access to security classified information and/or resources are willing to comply with the

security requirements that safeguard such information and resources against misuse, loss or compromise.

I also understand that my willingness to comply with the agency’s security requirements is a consideration in

the security clearance process. Furthermore, I understand that should I not be willing to comply with the

security requirements of the Shared Services ICT (SSICT) I will be assessed as unsuitable for a security clearance

at any level.

I certify that, in the course of any duties I may undertake as a Shared Services employee/Contractor, I

will comply with the security requirements that safeguard security classified information and/or

resources against misuse, loss or compromise.

I will comply with any Shared Services security instructions and directions.

I will comply with any reasonable direction given to me by authorised security personnel.

I understand that failure on my part to comply with the security requirements of Shared Services may

result in a review of my ongoing suitability for access to security classified information and/or

resources.

EXECUTED as a DEED POLL for the benefit of ACT GOVERNMENT as represented by the CMTEDD by:

Signature of Applicant: Date:

Witness Signature: Date:

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Appendix A - Supporting documentation There is a requirement to provide a 100 point identity check. *The following documents are considered mandatory

Primary Documents 70 Points Only one of the following may be claimed: Birth Certificate* Birth Card issued by a Registry of Births, Deaths and

Marriages Citizenship Certificate/status - Electronic VEVO visa

documentation supplied by the Immigration Department

Current Passport - the biographical data page only of a current passport can be supplied in lieu of a driver’s licence

Expired passport which has not been cancelled and was current within the preceding 2 years

Change of Name Certificate – required only if you have changed your name legally. If you use a name other than the one on your birth certificate please provide a brief explanation.

Secondary Documents 35 Points Name and address of signatory verified from any of

the following: o A document held by the cash dealer giving

security over the signatory’s property o A mortgage or other instrument of security held

by another financial body Must have name and address on:

o A mortgage or other instrument of security held by a financial body

o Local government (council) land tax or rates notice

o Document from your current employer or previous employer within the last 2 years

o Land Titles Office record o Document from the Credit Reference Association

of Australia

Secondary Documents 40 Points Drivers Licence* Document issued by Authorised Deposit-Taking

Institutions (ADIs), banks, building societies, credit unions or registered corporations. Signatory is a known customer of at least 12 months standing.

Written reference from one of the following institutions, verifying name of signatory and signed by both referee and signatory. Signatory must be known for at least 12 months. o Another financial body certifying that the

signatory is a known customer o Another customer who has been verified as a

signatory by the cash dealer o An acceptable referee (refer to AUSTRAC

Guideline No. 3 and Information Circular No. 3)

Secondary Documents 25 Points Must have name and signature on:

o Marriage Certificate (for maiden name only) o Credit Card o Foreign Driver Licence o Medicare Card (signature not required on

Medicare Card) o EFTPOS Card

Must have name and address on: o Electoral roll compiled by the Australian Electoral

Commission and available for public scrutiny o Records of a public utility - phone, water, gas or

electricity bill o Records of a financial institution o A record held under a law other than a law

relating to land titles o Lease/rent agreement o Rent receipt from a licensed real estate agent

Additional documentation may be requested if required. If you are unable to provide any of the supporting documentation please do not hesitate to contact the SSICT Physical and Personnel Security Team on 02 6207 2038 or via email on SSProtectiveSecurity@act.gov.au

Sensitive: Personal

(When completed)

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Appendix B - Guidelines for the certification of documents The following is a guide to help you prepare your certified documents correctly. Certified documents are copies of important documents which need to be certified as true copies of the originals by a person authorised to do so. A certified copy is a copy (often a photocopy) of a primary document that has on it an endorsement orcertificate that it is a true copy of the primary document. It does not certify that the primary document is genuine, only that it is a true copy of the primary document. Who can certify a copy? It is usual for documents to be certified by a person who is authorised as a witness for statutory

declarations under Statutory Declarations Regulations 1993– Schedule 2. This schedule provides a

wide range of authorised occupations and office holders who may certify a document, so finding a

suitable person should not normally present a significant difficulty.

How do I obtain a certified copy? Certification of Documents True copies and passports - “I certify this to be a true copy of the original which I have sighted” Name of Person making the certification Date: 10/10/09 Qualification to Certify: e.g., APS officer for 5 years and over, etc. Photos “This is the likeness of ...., whom I have known for more than 12 months” Name of Person making the certification Date: