Application for upgrade to be registered as a Justice of the Peace

Department of Justice and Attorney-General
Justices of the Peace Branch
Form 5a Queensland
Office use only
Application for upgrade
to be registered as a Justice
of the Peace (Qualified)
Registration number
ER
Justices of the Peace and Commissioners for Declarations Act 1991
Justices of the Peace and Commissioners for Declarations Regulation 2007
OS
For use where existing C.Dec wishes to upgrade to JP (Qual).
PN
L
Important explanatory notes—please read carefully
Application:
• MUST be completed in full unless the circumstances are exceptional. If handwritten, please use block letters;
Applicant:
• The applicant must have achieved competency through a Registered Training organisation.
Registration:
• After registration you will receive a certificate, seal, and registered number. You will be required to take another oath or affirmation
of allegiance and office.
• You should not assume office as a Justice of the Peace (Qualified) until you receive notification of your registration, although you
may continue in your role as a Commissioner for Declarations.
Changes of address:
• It is essential that you notify the Registrar of Justices of the Peace and Commissioners for Declarations of any changes of address
within 14 days.
Merchandise:
• Once registered as a Justice of the Peace (Qualified), you are entitled to purchase merchandise from the Department of Justice and Attorney-General. The range includes badges, key rings, stickers and letterbox signs. Phone 1300 301 147 or visit us online for more details.
Fees:
• An application fee is applicable. Please refer to www.justice.qld.gov.au/jps for the current fee schedule.
Please note:
Until you are registered as a Justice of the Peace (Qualified), you remain a Commissioner for Declarations and may continue
to exercise the powers of that office. For information on how to undertake an assessment of competency prior to sending this
application, please contact the JP Branch on ph 1300 301 147 or email [email protected]
Full name:
Mr 
Title:
Mrs 
Miss 
Ms  Other  ___________________________
Surname:
Given names/s:
If you have been known by any other name, please state other names:
Date of birth:
Place of birth:
Town
State or Region
Country
If not born in Australia, proof of Australian citizenship must accompany this application.
Residential
address in full:
Unit/Building No.
Street No.
Street Name
Suburb
State
Postcode
Enter “as above” if postal address is the same as residential address.
Postal address:
Unit/Building No.
Street No.
Street Name
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Suburb
Telephone:
State
Private
Postcode
Mobile
Great state. Great opportunity.
Client:
FINAL ARTWORK APPROVAL
Dept Justice & Attorney-General
Checked by client
Size
Client to complete:
Checked by: (print)
Job No.:
JPB11282 FORM 5(A)
Layout / size / fonts / images
...................................................
Size:
Flat: 210 x 297mm
Spelling
Approved: (sign)
Colours:
B/W
Compliant logo use
...................................................
Finishing:
N/A
Contact details
Staff:
Mark
Further corrections required
Date: ............ /............./.............
Corrections & Approvals
Whilst every effort is made to ensure correctness, the
final responsibility for checking the content, layout and
spelling remains with the client. No verbal approvals will
be accepted. Written confirmation must be given by the
client signing the form above for each job before Mariart
Design Studio will release material to a printer or the client.
Complete and fax to: (07) 3379 6931
Email:
Occupation:
Name of employer:
Address of employer:
Unit/Building No.
Street No.
Street Name
Suburb
Business telephone:
State
Postcode
Date of appointment as a C.Dec:
Please tick appropriate ‘yes’ or ‘no’ boxes.
Yes
No
1. Have you passed an examination for your nominated category set by a Registered Training Organisation?
A copy of your statement of attainment MUST accompany this application.
2. Are you correctly enrolled on the Queensland state electoral roll?
3. In which Queensland state Electoral District are you enrolled?
4. If you have lived outside Queensland, in which state did you last reside?
5. Are you an undischarged bankrupt or are you taking advantage, as a debtor, of the laws in
force for the time being relating to bankrupt or insolvent debtors?
6. If you speak a language other than English fluently, please indicate which language/s.
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All newly appointed Justices of the Peace (Qualified) will be listed on departmental websites. The listing includes contact details (i.e. name,
suburb, postcode and phone number) for JPs offering their services to the general public outside of normal business hours. If you are
unable to be included on the list, please provide your reasons below. © State of Queensland (Department of Justice and Attorney-General) 2014
Justices of the Peace Branch
Form 5a - Application for upgrade to be a registered Justice of the Peace (Qualified)
www.justice.qld.gov.au/jps
1300 301 147
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DECLARATION: To be completed by all applicants
Photo ID must be sighted. Identification required to process application (any two below):
Driver’s licence no.:
Expiry date:
Birth or Marriage Certificate:
Passport:
Credit card no.:
Health Benefit Card:
Pension card:
Medicare no:
Other:
I hereby apply to transfer my registration as a Commissioner for Declarations to registration as a Justice of the Peace (Qualified) for
Queensland and state that I am willing to undertake all duties attached to the Office and abide by the Code of Conduct for Justices of the
Peace (Qualified).
,
I,
(full name)
give my consent for the Department of Justice and Attorney-General, its employees and agents to seek a national criminal history check on
me through the Queensland Police Service, and for the Queensland Police Service and the Australian Police services to disclose criminal
history information, including charges laid against me awaiting determination, to the Department of Justice and Attorney-General, its
employees and agents.
I understand the disclosure of information about my criminal history will be subject to Commonwealth, State or Territory legislation where it
applies, or the policy of the police service making disclosure or both.
I consent to the Registrar of Justices of the Peace and Commissioners for Declarations making confidential inquiries as to my character and
suitability for appointment through the relevant agency/s and its employees.
I hereby certify that the statements made in this, my application for transfer of appointment to a Justice of the Peace (Qualified), are true
and correct in every particular.
Dated this
Day of
20
Signature of applicant:
Witnessed by:
To be witnessed ONLY by a Commissioner for Declarations, Justice of the Peace (Qualified)
or Justice of the Peace (Magistrates Court) for the State of Queensland.
Stamp and Registration No.:
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Privacy statement:
The Department of Justice and Attorney-General is collecting the information on this form for the purpose of determining your eligibility to be appointed as a
Justice of the Peace (Qualified). The collection of this information is authorised by the Justices of the Peace and Commissioners for Declarations Act 1991 and
the Justices of the Peace and Commissioners for Declarations Regulation 2007. Only authorised departmental employees and contractors will have access to this
information. Your identifying details will be provided to the Queensland Police Service for the purpose of obtaining your criminal history. If you are appointed as a
Justice of the Peace (Qualified) your name, address and particulars of appointment will be entered in the Register of Justices of the Peace and Commissioners for
Declarations where it will be accessible by members of the public.
© State of Queensland (Department of Justice and Attorney-General) 2014
Justices of the Peace Branch
Form 5a - Application for upgrade to be a registered Justice of the Peace (Qualified)
www.justice.qld.gov.au/jps
1300 301 147
3/4
Nomination (NOTE: Only one (1) portion of this section is to be completed).
EITHER Local Member
I, ,
(full name)
Member of the State Parliament of Queensland for the electoral district of ________________________________________________________ , am satisfied that the applicant resides within that electoral district and unaware of any reason to suggest that the applicant is not a fit and
proper person to be appointed to this office.
Dated this
day of
20
Signature of nominator
OR business nominator
Where the applicant seeks appointment to carry out duties in a bank, building society, credit union, insurance office or in the Commonwealth or
State public service, and for reasons of time or distance, or for business reasons, it is not convenient for the applicant to call on his/her Member
of State Parliament of Queensland. (Note: The nominator in this case must be either—(i) the General Manager of the institution; or (ii) the Chief
Executive of the Government Department concerned or his/her delegate.)
,
I, (full name)
,
(official position held)
am satisfied that the appointment is necessary to enable the applicant to carry out the duties of his/her office and that the applicant is a fit
and proper person, is familiar with and appreciates the obligations, and is suitable to be appointed as a Justice of the Peace (Qualified) for
Queensland. The reason/s it is more convenient for the applicant to be nominated through this process rather than call on his/her Member of
State Parliament is/are:
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________
______________________________________________________________________________________________________________________ Dated this
day of
20
Signature of nominator
OR other Member for reasons of time and distance
Where the applicant finds it inconvenient for reasons of time or distance or for business reasons to call on his/her Member of the State
Parliament of Queensland or where the above forms of nomination are inappropriate given the particular circumstances of the applicant. (Note:
The nominator in this case must be any member of a parliament in Australia.)
,
I, (full name)
Member of : state that the applicant is known/not known (delete whichever is not appropriate) to me and I am unaware of any reason to suggest that the
applicant is not a fit and proper person to be appointed to this office.
Dated this
day of
20
,
Signature of nominator
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When completed, this application form must be forwarded to:
The Registrar of Justices of the Peace and Commissioners for Declarations
Department of Justice and Attorney-General, PO Box 5894, WEST END Qld 4101.
© State of Queensland (Department of Justice and Attorney-General) 2014
Justices of the Peace Branch
Form 5a - Application for upgrade to be a registered Justice of the Peace (Qualified)
www.justice.qld.gov.au/jps
1300 301 147
4/4

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