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Certificate of Employment Security Guard document sample
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Return Address: PIs and Security Guards
Private Bag 92020
AUCKLAND
Courier Address: Occupational Licencing
5th Floor, 69 Albert St
Auckland District Court
Dear Sir/Madam
RENEWAL OF SECURITY GUARD LICENCE BY AN INDIVIDUAL
AND CERTIFICATES OF APPROVAL
I remind you that all Licences and Certificates of Approval will EXPIRE on
31st March 2011.
Therefore, if you wish to continue to hold a licence you must advertise and apply for
the renewal of your Licence and Certificates of Approval no earlier than
01/01/2011 and no later than 28/02/2011.
For your information please note the following facts:
If an application for renewal of a Licence or Certificate of Approval has been
made it continues in force (past the 31 March 2011) until it has been
determined by the Registrar.
All renewal applications are considered separately by the Police and you will
therefore not receive back your Licence and Certificates in one group.
RENEWALS RECEIVED AFTER THE 28TH FEBRUARY 2011 WILL NOT BE
ACCEPTED.
IMPORTANT REQUIREMENTS
To renew your Licence file the following:
Application for Renewal (Form 8) in DUPLICATE (SG number to be shown on
the top right-hand corner of the form. It is the same as last year.)
Renewal fee of $122.66 (GST incl.). Cheques to be made payable to ‘Ministry of
Justice’.
3 passport sized photographs (each photograph to have applicants name and SG
number noted on the back).
Proof of advertising. The Full page of the advertisements MUST be
supplied, clippings or photocopies will be REJECTED. Please
highlight/circle your advert on the page. (Enclosed is the form of advertisement
(Form 9) to be completed and published by you in a main daily newspaper
twice within 14 days of each other.)
District Court
65-69 Albert Street, Private Bag 92020, DX CP24043, Auckland, New Zealand
Telephone: 0-9 916 9045 Fax: 0-9 916 9047
To renew Certificates of Approval (COA) file the following:
Application for Renewal (Form 12) in DUPLICATE (SG(e) number to be
shown). Please note that if the COA has an expiry date before 31 st March 2011
then a new Application form (Form 11) must be completed.
3 passport sized photographs (each photograph to have applicants name and
SG(e) number noted on the back).
Renewal fee of $81.77 (GST incl.). Cheques to be made payable to ‘Ministry of
Justice’.
Complete the Cover Sheet with details of each COA applied for. We do not
require the Cover Sheet to be completed for new applications.
Name changes – please forward copy of Marriage Certificate or Deed Poll notice.
If your business has now become a limited liability company, you must
apply to change your licence to a company licence. Please contact this
office for information on requirements to be sent to you.
Certificate of Approval (COA) Forms are enclosed for any new employees (Form 11).
Please note: If new COAs are applied for during the Renewal period you
need to attach a separate cheque to enable this office to prioritise such
applications.
Yours faithfully
Lucy Tipanero
Private Investigators and Security Guards Office
APPLICATION FOR RENEWAL OF LICENCE
FOR A SECURITY GUARD (INDIVIDUAL)
FORM 8
Please staple
To: The Registrar of Private Investigators and Security Guards SG No: Photos here
Private Bag 92020, AUCKLAND (MUST BE SHOWN)
IMPORTANT NOTES
1. This application is to be filed in duplicate together with the application fee of $122.66.
Cheques to be made payable to ‘Ministry of Justice’.
2. In addition you are required to give notice of your application by advertisement (Form 9),
twice within 14 days in a main daily newspaper (e.g Auckland – Herald/ Wellington-
Dominion Post/ Christchurch – Press/ Otago – Daily Times) in your area.
3. 3 passport sized photographs (each photograph to have applicants name and SG
number noted on the back).
4. If you have any enquiries you are invited to seek the advice of the Registrar who will be
pleased to assist you. Phone (09) 916-9045 or (09) 916 9265
PURSUANT to Section 33 of the Private Investigators and Security Guards Act 1974,
I, (First Names) (Surname)
(Full name of Licence Holder)
DATE OF BIRTH: / / Occupation
Trading As
(Trading Name, if applicable)
of
(Address of Registered Office)
being the holder of a security guards licence, hereby apply for the renewal of that
licence for the year ending with the 31st day of March 2011.
POSTAL ADDRESS:
E-MAIL ADDRESS:
PHONE: FAX: MOBILE:
ADDITIONAL PLACES
OF BUSINESS: __
CLASSES OF LICENCE: A B C D E (Please circle)
SIGNATURE OF APPLICANT: DATE: / /2011
OFFICE USE ONLY
App received DateTo Police
Fee Paid $122.66 Granted
Cheque Number Date Licence sent
Newspaper Advertisement dates / / AND / /
(Draft Advertisement)
FORM 9
APPLICATION FOR RENEWAL OF A LICENCE UNDER THE
PRIVATE INVESTIGATORS AND SECURITY GUARDS ACT
1974
TAKE NOTICE that I
(Trading as)
of
have applied to the Registrar of Private Investigators and Security
Guards, (c/o District Court, Auckland) for renewal of my Security Guards
Licence.
Any person wishing to object pursuant to Section 23(2) & 33 of the Act
must give written notice of the objection to the Registrar no later than
one month after the first publication of this notice.
A copy must also be served on me at the above address (or at the
following address: )
within seven days of notification to the Registrar.
This is the first publication of this notice.
OR
The notice was first published on the ____day of__________ 2011
APPLICANT
APPLICATION FOR RENEWAL OF CERTIFICATE OF
APPROVAL FOR A SECURITY GUARD EMPLOYEE
FORM 12 Please staple
Photo’s here
To: The Registrar of Private Investigators and Security Guards SG(e) No:
Private Bag 92020, AUCKLAND (MUST BE SHOWN)
IMPORTANT NOTES
1. This application is to be filed in duplicate together with the application fee of $81.77.
Cheques to be made payable to ‘Ministry of Justice’.
2. 3 passport sized photographs (each photograph to have applicants name and SG(e)
number noted on the back).
3. If you have any enquiries you are invited to seek the advice of the Registrar who will be
pleased to assist you. Phone (09) 916-9045 or (09) 916 9265
PURSUANT to section 44 of the Private Investigators and Security Guards Act 1974,
I, SG:
(Full name of licensee: First Names Surname) (SG number of licensee)
of Ph No:
(Address of Registered Office)
being the employer of
(First Names) (Surname)
(Full name of Responsible Employee)
of Ph No:
(Residential Address)
DATE OF BIRTH / / , (Occupation) =
who is the holder of a certificate of approval to be a responsible employee of a security guard hereby
apply for the renewal of that certificate of approval for the year ending with the 31st day of March
2011.
The postal address I require the certificate, if approved, to be forwarded to is (please include the
name of the person the envelope is to be made attention to if applicable):
(Postal Address)
Dated at this day of 2011.
Signature of EMPLOYER
OFFICE USE ONLY
App received To Police Certificate sent
Fee Paid $81.77 Batch No.
Cheque Number
Granted
COVERSHEET
OFFICE ------------ USE -------------- ONLY
SG(E) NUMBER SURNAME FIRST NAMES DATE OF BIRTH OBJECTION NO OBJECTION COMMENTS
DD/MM/YY
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
/ /
OFFICE USE ONLY BATCH SHEET NUMBER:
DATE SENT: DATE RECEIVED: CHEQUE NUMBER: CHEQUE AMOUNT:
APPLICATION FOR APPROVAL OF RESPONSIBLE
EMPLOYEE OF SECURITY GUARD
Please staple
Photos here
FORM 11
To: The Registrar of Private Investigators and Security Guards SG(e) No:
Private Bag 92020, AUCKLAND
IMPORTANT NOTES
1. This application is to be filed in duplicate together with the application fee of $81.77. For
applications filed from 1 October to 31 December the fee is $71.55. Cheques to be made
payable to ‘Ministry of Justice’.
2. 3 passport sized photographs (each photograph to have applicants name noted on the
back).
3. The Statutory Declaration must be completed by deleting one of the options in questions 2,
3 and 4.
4. If you have any enquiries you are invited to seek the advice of the Registrar who will be
pleased to assist you. Phone (09) 916-9045 or (09) 916 9265
PURSUANT to section 36 of the Private Investigators and Security Guards Act 1974,
I/We, ........................................................................................................ ....................
(Full name Licensee) (SG Number)
(MUST BE SHOWN)
of ..............................................................................................................................................
(Address of registered office) Please give phone contact details
being the holder of a security guard's licence, seek your approval to the employment, in my business
as a security guard, of ......................................................................................., of
(Full name of proposed employee)
.................................................................................................. Date of Birth..... /...../........
(Residential address)
as a responsible employee.
The postal address I require the certificate, if approved, to be forwarded
to is (please include the name of the person the envelope is to be made
attention to if applicable):
(NOTE: The Certificate can only be mailed to the employer, not to the employee)
Signed at ................................................. this .................. day of .................................... 2011.
........................................................
Signature of Employer.
OFFICE USE ONLY
App received To Police Granted
Fee Paid Certificate sent
Cheque Number Police report
received
SUPPORTING DECLARATION BY PROPOSED EMPLOYEE
I, (First Names) ...............................................................................(Surname)............................................
(Full name – please include Maiden name, known name or any alias)
of.............................................................................................................................................. ................
(Residential address) (Contact Phone No.s)
solemnly and sincerely declare as follows:
1. That I was born on ..................../................/ .................
(Specify date of birth)
at................................................................................................................................
(Specify place and country of birth).
2. That I have not previously held a security guard’s licence or a certificate of approval to be a
responsible employee of a security guard that has been cancelled at any time within the last 5 years.
OR (delete the statement which is not applicable)
That a security guard’s licence or a certificate of approval to be a responsible employee of a security
guard held by me was cancelled on the ................day of ......................... 20..... .
3. That I have not been convicted of a crime involving dishonesty or a specified offence at any time
within the last 5 years.
OR (delete the statement which is not applicable)
That I have been convicted of a crime involving dishonesty or a specified offence at any time within
the last 5 years: [Give details.]
....................................................................................................................................................
4. That I have not been detained in a penal institution at any time within the last 5 years.
OR (delete the statement which is not applicable)
That I have been detained in a penal institution within the last 5 years as follows:
[Give details of sentence(s) served, and the nature of the offence(s) of which you were convicted. ]
....................................................................................................................................................
And I make this solemn declaration conscientiously believing the same to be true and by virtue of the Oaths and
Declarations Act 1957.
Declared at ..................................................... this .............. day of ................................, 20......
Signature of Proposed Employee
...........................................................................................................................
Before me......................................................... .....
Justice of the Peace, Solicitor or other person Authorised to take statutory
declarations.
NOTES
1. If you have been convicted of a crime involving dishonesty or a specified offence within the
previous 5 years, you must list these convictions under clause 3 of this form. For your
information,
(a) Crimes involving dishonesty are those crimes described in sections 108 to 117 and
section 217 to 292 of the Crimes Act 1961. The crimes described in these sections
are
(i) Misleading justice (in particular, perjury, false oaths, false statements or
declarations, fabricating evidence, use of a purported affidavit or
declaration, conspiring to bring a false accusation, conspiring to defeat
justice, and corrupting juries and witnesses):
(ii) Theft (including theft of animals, theft by a person required to account, theft by
a person holding power of attorney, theft by misappropriating proceeds
held under direction, theft by a co-owner, and theft by a husband or
wife):
(iii) Crimes resembling theft (in particular, conversion or attempted conversion
of motorcars etc., possession of instruments for conversion, taking or
dealing with certain documents with intent to defraud, criminal breach of
trust, fraudulently destroying a document, fraudulent concealment, and
bringing stolen things into New Zealand):
(iv) Robbery and extortion (including aggravated robbery, compelling
execution of documents by force, assault with intent to rob, extortion by
certain threats, and demanding with intent to steal):
(v) Burglary (including entering with intent, being armed with intent to break
or enter, and being disguised or in possession of instruments for
burglary):
(vi) False pretences (in particular, obtaining by false pretence and obtaining
credit fraudulently):
(vii) Personation and acknowledging an instrument in a false name:
(viii) Fraud (in particular, false statement by a promoter, falsifying accounts
relating to public funds, false accounting by an officer or member of a
body corporate, false accounting by an employee, false statement by a
public officer, issuing false dividend warrants, concealing deeds and
encumbrances, and conspiracy to defraud):
(ix) Receiving (in particular, receiving property dishonestly obtained, receiving
property of a husband or wife, and taking a reward for recovery of stolen
goods):
(x) Forgery (including uttering forged documents, altering or reproducing a
document with intent to defraud, using an altered or a reproduced
document with intent to defraud, counterfeiting public or corporate seals,
sending a false telegram, procuring execution of a document by fraud,
possessing forged bank notes, drawing a document without authority,
using probate obtained by forgery or perjury, paper or implements for
forgery, counterfeiting stamps, falsifying registers, falsifying extracts from
registers, uttering false certificates, forging certificates, and imitating
authorised marks or customary marks):
(xi) Coinage (in particular, preparations for coining, counterfeiting coin,
altering coin, impairing coin, defacing coin, melting coin, possessing or
uttering counterfeit coin, buying and selling counterfeit coin, and
importing and exporting counterfeit coin):
(b) Specified offences are those crimes described in sections 104, 105B, 158 to 181, 188
to 204, and 216B to 216D of the Crimes Act 1961. The crimes described in these
sections are
(i) Corruption and bribery of a law enforcement officer and use or disclosure
of personal information disclosed under section 105A of the Crimes Act
1961:
(ii) Murder and manslaughter offences (including attempt to murder,
counselling or attempting to procure murder, conspiracy to murder, being
an accessory after the fact to murder, infanticide, aiding and abetting
suicide, suicide pacts, and concealing the dead body of a child):
(iii) Assaults and injuries to the person (in particular, wounding with intent,
injuring with intent, injuring by an unlawful act, aggravated wounding or
injury, aggravated assault, assault with intent to injure, assault on a child,
cruelty to a child, common assault, disabling, discharging a firearm or
doing a dangerous act with intent, using any firearm against a law
enforcement officer, commission of a crime with a firearm, acid throwing,
poisoning with intent, infecting with disease, setting traps, possession of
offensive weapons or disabling substances, endangering transport, and
impeding rescue):
(iv) Crimes against personal privacy (in particular, prohibition on the use of
listening devices, prohibition on the disclosure of private communications
unlawfully intercepted, and prohibition on dealing etc., with listening
devices):
(c) Specified offences are also those crimes described in sections 3, 5, 5A, 6, 9, 10, 14,
15, 18, 19, 20, or 21 of the Summary Offences Act 1981. The crimes described in
these sections are
(i) Offences against public order (in particular, disorderly behaviour,
disorderly behaviour on private premises, disorderly assembly, and
associating with convicted thieves):
(ii) Offences against persons and property (in particular, common assault,
assault on a police, prison or traffic officer, and possession of burglary
tools):
(iii) Offences resembling forgery or fraud (in particular, seeking donations by
false pretences, imitation of Court documents, imitation of official
documents, false claim of qualifications, and intimidation).
2. This application must be accompanied by the application fee of $81.77 and by 3 identical
photographs of the proposed employee. The photographs must be of good quality, show the
head and shoulders of the proposed employees, and measure between 2.5 and 4 centimetres
in width and between 2.5 and 5 centimetres in height.
3. If the applicant or the responsible employee has any queries he or she should ask the Registrar
who would be pleased to assist him or her.
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