Order Multiple Background Screening Checks

Personal Information

Double Check NZ Ltd is committed to maintaining the privacy of both Clients and Candidates. To ensure that all Candidate and Client information is protected, Double Check NZ Ltd complies with the New Zealand Privacy Act 1993.

You will be able to acknowledge our full privacy statement at the end of this form.

Name:*

First Middle Last

Date of Birth:*

DD

MM

YYYY

Gender:*

Male
Female

Any other names you were previously known as:

First Middle Last

Email:*

Phone:*

Ministry of Justice Criminal Record and Traffic Conviction History

Important: Please ensure the name and DOB you enter in this section match the identification that you upload.

If you are ordering more than one check you may be asked for this information multiple times. Click here to find out why.

Name:*

First Middle Last

Date of Birth:*

DD

MM

YYYY

Gender:*

Male
Female

Place of Birth:*

Telephone:*

Mobile:

Email:*

Previous names – Maiden names, other names you are known as, or have used.

First Middle Last

Postal Address:*

Street Address Suburb Town/City State/Province Post Code Country

Residential Address:

If different to postal address.

Street Address Suburb Town/City State/Province Post Code Country

Please list other New Zealand Addresses you have lived at in the past 10 years.

Address 1:

Street Address Suburb Town/City Post Code

Address 2:

Street Address Suburb Town/City Post Code

Address 3:

Street Address Suburb Town/City Post Code

Your Identification*

Please attach a legible photocopy of your identification which must contain your signature. This can be any one of the following:

New Zealand Driver Licence – can be current or expired within the last 2 years, but cannot be cancelled, defaced or a temporary licence.
New Zealand Passport – can be current or expired within the last 2 years, but cannot be cancelled or defaced. Must show your signature.
Overseas Passports – must be current and cannot be expired, cancelled or defaced. Must show your signature.
New Zealand Firearms Licence – must be current and cannot be expired or defaced.
I don't have any valid forms of ID.

Unfortunately, we cannot process your application online and will need to do this manually. Please get in touch with us here and we will be happy to help.

Identification Upload (5MB Max):*

I authorise the Criminal Records Unit, Ministry of Justice, to release a copy of my criminal convictions, subject to section 7 of the Criminal Records (Clean Slate) Act 2004, to Double Check NZ Ltd ("The Third Party").

Tick the report required:*

Criminal and Traffic convictions report
Traffic convictions report

I want a copy of the information supplied to Double Check NZ Ltd.*

Yes
No

Date:*

DD

MM

YYYY

Signature:*

Digital signatures are not allowed by the New Zealand Minstry of Justice. Please upload a scanned copy of your signature on a white background that is a direct match to the one on your provided Identification.

Ministry of Justice Checks

Price: $ 45.00

Background Credit Check

Current Address:*

Street Address Address Line 2 City/Town Region Post Code

Previous Address:*

Street Address Address Line 2 City/Town Region Post Code

Driver's License Number:*

Copy of Driver's License:*

Please upload a scan or photo of your Driver's License (5MB Maximum).

I understand that the position which I have applied for involves significant financial risk and I therefore authorise Double Check NZ to carry out the following:

Credit Reporting Services to give you information about me for the purpose of a pre- employment check for a position involving significant financial risk;

You to give my personal information to Credit Reporting Services, and that I agree that those Reporting Services will hold that information on their systems and use it to provide their credit reporting service. When other customers use the credit reporting service, this information may be given to those customers.

I understand that Double Check NZ Ltd is asking me to provide personal information to use to verify my CREDIT HISTORY.

Signature:*

Today's Date:*

DD

MM

YYYY

Background Credit Check

Price: $ 45.00

Driver's License History

Current Address:*

Street Address Address Line 2 City/Town Region Post Code

Previous Address:*

Street Address Address Line 2 City/Town Region Post Code

Driver's License Number:*

Copy of Driver's License:*

Please upload a scan or photo of your Driver's License (5MB Maximum).

I understand that Double Check NZ Ltd is asking me to provide personal information to use to verify my DRIVERS LICENSE HISTORY. I authorise the NZ Transport Agency to email my results directly to Double Check NZ Ltd

Signature:*

Today's Date:*

DD

MM

YYYY

Driver's License History

Price: $ 45.00

Certificate of Particulars

Double Check NZ Ltd is committed to maintaining the privacy of both Clients and Candidates. To ensure that all Candidate and Client information is protected, Double Check NZ Ltd complies with the New Zealand Privacy Act 1993.

To verify your Certificate of Particulars, please provide the following information:

Current Address:*

Street Address Address Line 2 City/Town Region Post Code

Previous Address:*

Street Address Address Line 2 City/Town Region Post Code

Driver's License Number:*

Copy of Identification:*

Please upload a legible copy of your Passport or Drivers License (maximum file size 5MB).

I understand that Double Check NZ Ltd is asking me to provide personal information to use to verify my Certificate of Particulars with the NZTA. I authorise you to send my results to Double Check NZ Ltd. for the purpose of this check.

Signature:*

Today's Date:*

DD

MM

YYYY

Certificate of Particulars

Price: $ 45.00

Employment History

Company Name:*

Company Phone Number:*

Position Held:*

Period of Employment:

Please include your start date and finish date.

Salary/Wage in this position:

Detail your role and responsibilities:*

Manager Name:*

Manager Contact Information:*

Manager's Current Position:*

Manager's Relevant Position:

(The position of your Manager when you reported to them, if different to their current position).

How long have you known each other?*

Employment History

Price: $ 45.00

Pre Tenancy Application:

Please complete this form to apply for the tenancy at the address below. The information you provide is for applying for this tenancy and may be used for a credit and reference check.

Address of Tenancy you are applying for:*

Street Address Address Line 2 City Post Code Country

Proposed Commencement Date of Tenancy:*

DD

MM

YYYY

Current Address:*

Street Address Address Line 2 City Post Code Country

How long have you lived there?*

Please state total time at this address e.g. 2 years 6 months.

Why are you leaving this address?*

Identification:*

Please upload a legible copy of your drivers license or passport (Max file size 5MB). This is used for id verification and credit check purposes only.

Vehicle:

If you drive a vehicle, please state the make, model, and registration number.

Emergency Contact Details:*

Please enter the name and details of an emergency contact.

Emergency Contact Phone:*

Emergency Contact Email:*

Emergency Contact Address:*

Street Address Address Line 2 City Post Code Country

Are you currently renting?*

Yes
No

Landlord Name:*

First Last

Landlord Email:*

Landlord Phone:

Do you authorise us to contact your landlord for a reference?*

Yes
No

Please provide two referees that we can contact. Referees can be a friend, co-worker, your employer or someone who knows you well. One of your referees should be able to provide a reference about your creditworthiness. If you authorised us to contact your current landlord, only one additional referee is needed. Please let these people know we will be contacting them for a reference.

Referee One Name:*

First Last

Email:*

Phone:*

Referee Two Name:

First Last

Email:

Phone:

I authorise the Landlord/Property Manager to:

collect, retain and use this information for the purpose of assessing my creditworthiness and suitability for the tenancy; and
disclose information about me, whether collected from me directly or from any other source, to any other credit provider or any credit reporting agency for the purposes of providing or obtaining a credit report (which will involve the credit reporting agency providing information about me to the Landlord/Property Manager).

I understand that the credit reporting agency:

may hold my information on their credit reporting database and use it for providing credit reporting services, and they may disclose my information to their subscribers for the purpose of credit checking or debt collection; and
as part of providing a credit report, may check the Ministry of Justice fines database for any overdue fines I may have.

Under the Privacy Act 1993, you have the right to ask for a copy of all information held about you, and have the right to request the correction of any incorrect information.

Type Your Name:*

Today's Date:*

DD

MM

YYYY

Signature:*

Pre Tenancy Application Check:

Price: $ 45.00

Education/Qualification History

Double Check NZ Ltd is committed to maintaining the privacy of both Clients and Candidates. To ensure that all Candidate and Client information is protected, Double Check NZ Ltd complies with the New Zealand Privacy Act 1993.

To Verify your highest Education Qualification, please provide the following information.

Name of University, College, School or Institution:*

Institution Address:*

Street Address Address Line 2 City Region Post Code Country

Qualification Attained:*

Start Date:*

DD

MM

YYYY

Completion Date:*

DD

MM

YYYY

Graduation Date:*

DD

MM

YYYY

Name of Qualification Received:*

Alternative Name:

If your Qualification was presented to you under a past or alternative name, please list it here.

First Middle Last

Student ID (If known):

Identification:*

Please upload a legible copy of your passport for identification verification. (Max file size 5MB).

Copy of Certificate and/or Transcript:*

Please upload a copy of your degree/certificate and/or transcript from your institution (max file size 5MB).

I understand that Double Check NZ Ltd is asking me to provide personal information to use to verify my Education Qualification. I authorise my institution to release these results for verification purposes to Double Check NZ.

Type your full name:

Today's Date:*

DD

MM

YYYY

Signature:*

Education/Qualification Verification:

Price: $ 45.00

Visa Verification & Entitlement to work

Current Address:*

Street Address Address Line 2 City Region Post Code Country

Nationality as indicated on your passport:*

Start Date of Visa:*

DD

MM

YYYY

I understand that Double Check NZ Ltd is asking me to provide personal information to use to verify my Passport & Visa. I authorise New Zealand Immigration to provide my results directly to Double Check NZ Ltd.

Type your name:*

Enter today's date:*

DD

MM

YYYY

Signature:*

Visa Verification Check:

Price: $ 45.00

ACC Claims History

ACC requires that all applicants fill out their specialised application form and sign by hand. Because of this, we are unable to offer this through a true online form. Please download ACC's form here, complete, and then re upload using the steps below:

Completed Form:*

Please upload your completed ACC form here (5MB max.)

ACC Claims History:

Price: $ 45.00

Double Check NZ Privacy Statement

We wish to verify the personal information you have provided regarding your background and/or employment history, by carrying out verification checks. The personal information you have provided and any other information collected during the verification process may be used in the course of considering you application.

Although documents may request information regarding your age, gender, previous/maiden names, addresses and national origin, it will only be used for the purpose of requesting information from agencies or other sources which require this information in order to process requests for information.

Double Check NZ Ltd, has been engaged to conduct background checks and to verify some or all of the information you have provided.

Double Check NZ Ltd is committed to maintaining the privacy of both clients and Candidates. To ensure that all Candidate and Client information is protected Double Check NZ Ltd complies with the New Zealand Privacy Act 1993.

I authorise Double Check NZ Ltd and any of its affiliates, persons or organisations acting on its behalf to verify information presented in my application and to collect additional information which may be relevant to my application. I understand that this information may be disclosed to third parties for the purposes of verifying my information

Print Full Name:*

Today's Date:*

DD

MM

YYYY

Signature:*

Order Background & Screening Checks

Step 1 of 3

Personal Information

Ministry of Justice Criminal Record and Traffic Conviction History

Background Credit Check

Driver's License History

Certificate of Particulars

Employment History

Pre Tenancy Application:

Education/Qualification History

Visa Verification & Entitlement to work

ACC Claims History

Double Check NZ Privacy Statement

Cost

Payment Information