Membership Manager

New Application

Initial

Personal Details

Address

Proof of ID

In Case of Emergency

Declaration

Enter a postcode or unit name:

What sort of work would you like to do with MRNSW?

Tell us about what skills/experience you have that could be of help to MRNSW?

How did you learn about us?

How much time per month (on average) do you think you could commit to MRNSW for training/activities?

Gender:

Title:

Family Name:

First Name:

Middle Name(s):

Home Phone:
(including area code)

Work Phone:
(including area code)

Mobile Phone:

Other Names

If you have had previous names, such as maiden name or alias, please complete here to assist in your Police Check

FILL IN both First and Family name, AND Middle name if you have one.

Other Family Name	Other First Name	Other Middle Name(s)	Type
No other names

Other Family Name:

Other First Name:

Other Middle Name(s):

Email Address:

Date of Birth:

Suburb/Town of Birth:

State of Birth:

Country of Birth:

Employment Status:

Occupation:

Qualifications:

Boat Licence #:

Boat Licence Expiry:

Previous membership of MRNSW:

Marine Rescue NSW will only use your contact details to provide you with information or updates that we believe are relevant to you as an active or operational member. Our member’s magazine Soundings magazine will be sent to you each quarter. From time to time other materials containing information in relation to MRNSW suppliers or business supporters may be sent to members. Members details are not disclosed to any third parties except where legally required.

I do not wish to receive Soundings magazine

I do not wish to receive other marketing material

Residential Address

Unit/Street Number:

Street Name:

Suburb:

Postcode:

State:

Country:

Date from:

Previous Addresses Your Police Check will require 5 years of residential history, please provide that history below. Please click the blue Add button to add addresses.

Unit/Street Number:

Street Name:

Suburb:

Postcode:

State:

Country:

Date of Residence:

Postal Address

Same as residential address

Unit/Street Number:

Street Name:

Suburb:

Postcode:

State:

Country:

Marine Rescue NSW is listed with the Australian Criminal Intelligence Commission (ACIC) as an accredited body, meaning that the information contained within this application will be used to process your police check.

Police information is disclosed in accordance with applicable legislation and information release policies of the Australian Government and state and territory governments.

In addition to the information you input below, you will need to bring these original and other additional documents to your upcoming interview with your selected Unit as part of the identity verification process for ACIC. For more information about what documents are required please click here

Please provide at least either Licence or Passport details

Australian Drivers Licence No
(if available, else leave empty):

Issued by:

Firearms Licence No
(if available, else leave empty):

Issued by:

Passport No:
(if available, else leave empty):

Country:

Next of Kin (in case of emergency)

Contact name

Relationship:

Contact Phone number

Backup Phone number

Same as my residential address

Unit/Street Number:

Street Name:

Suburb:

Postcode:

State:

Country:

Medical Declaration: If you do have a medical condition or disability that affects your ability to carry out assigned duties, you have an obligation under Workplace Health and Safety Regulations to notify your Unit Commander prior to starting or continuing service. Matters of this nature can be discussed in strictest confidence:

I do not suffer any medical condition or disability which may impair or limit my capacity to carry out my assigned duties or which may place me and/or others at risk while carrying out those duties.

I do have a medical condition or disability which may impair or limit my capacity to carry out my assigned duties or which may place me and/or others at risk while carrying out those duties. I will disclose and discuss this with my Unit Commander at interview.

Declaration: I hereby apply for membership of Marine Rescue NSW. I understand and undertake that, if accepted, I shall:
- Guarantee the liability of Volunteer MRNSW to a maximum of $2.00
- Agree to be bound by the Constitution, Rules, By-laws, Code of Conduct (link) and Operational Procedures of MRNSW
- Consent to my photograph being taken for my identification badge
- Satisfactorily complete any induction course and relevant probationary period
- Undergo any training and assessment required for qualifications, competency and/or promotion within MRNSW
- I am an Australian Citizen or Resident
Informed Consent: I give my consent to MRNSW to submit a nationally coordinated criminal history check as part of my membership application (View Terms & Conditions)

Click here to view our privacy policy.

Thank you! Your membership application for Marine Rescue NSW has been successfully submitted.

Your registration number is MR

A representative from your selected Unit will contact you shortly to arrange a personal meeting with you to explain the next steps and for you to verify your original identity documents before we can proceed with your application.

Congratulations on taking this first step and we hope you enjoy the journey with us.

Marine Rescue NSW

I, the applicant:

1. Acknowledge that I/the applicant understand the information on this form.

2. Acknowledge that the accredited body (MRNSW) is collecting information in this form to provide to the Australian Criminal Intelligence Commission (ACIC) and police agencies, for a nationally coordinated criminal history check to be conducted.

3. Have fully and accurately completed this form, and the personal information I/the applicant, have provided relates to me/the applicant, and contains the full name and all names previously used by me/the applicant.

4. Acknowledge that withholding and/or providing misleading or false information on this form and in any supplied identity documents is a Commonwealth offence and may lead to prosecution under the Criminal Code Act 1995 (Cth).

5. Acknowledge that personal information that I/the applicant provided in this form and on the supplied identity documents may be disclosed to the accredited body (MRNSW) (including contractors, legal entity customers, related bodies or third parties named in Section 2 of this form in Australia or overseas, if applicable).

6. Acknowledge that any information sent by mail or electronically, in relation to this form, including identity documents, is sent at my/the applicant’s risk and I/the applicant, am aware of the consequences of sending information in these ways.

7. Acknowledge that I/the applicant am aware that I/the applicant am providing consent for a national check to be conducted on all personal information provided in this form and provided in suppled identity documents.

8. Understand and consent to police information relating to me/the applicant, being disclosed in accordance with the purpose identified in section 1 of this form, applicable legislation and information release policies (including spent convictions legislation described in Australian Government and state or territory legislation).

9. Give consent to:

a. the ACIC and police agencies using and disclosing my/the applicant’s personal information that I/ the applicant, have provided in this form and personal information contained in my supplied identity documents to conduct a nationally coordinated criminal history check.

b. the ACIC disclosing the police information sourced from the police agencies to other approved bodies and the accredited body (MRNSW).

c. the accredited body (MRNSW) disclosing to the legal entity customer, third parties and any permitted offshore transfer arrangements also detailed in Section 2, my/the applicant’s personal information and police information to assess my/the applicant’s suitability for the purpose identified in section 1 of this form.

d. acknowledge that it is usual practice for my/the applicant’s personal information and police information to be used by police agencies and the ACIC for law enforcement, including purposes set out in the Australian Crime Commission Act 2002 (Cth).

New Application

Other Names

Please provide at least either Licence or Passport details

Informed Consent Terms and Conditions