Guardian Interlock Installer or Service Provider Application Form

Step 1 of 0
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Select one option only

2. Applicant Details

Relevant Qualifications

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mark n/a if not valid
Service providers please provide brief summary of administration experience
Click or drag files to this area to upload. You can upload up to 10 files.

3. Criminal History

I acknowledge that submission of this application does not guarantee approval as an Interlock Installer or Service Provider. I understand that my personal information is being collected and held by Guardian Interlock Systems, 8/11 Packard Ave, Castle Hill NSW 2154. I have a right to access or correct my personal information in accordance with the provisions of the relevant privacy legislation. The information supplied may be disclosed in accordance with the exemptions provided in the Privacy and Personal Information Protection Act 1998.

OFFICE USE ONLY - DO NOT COMPLETE

5. Guardian Program Manager's Declaration

I certify that the applicant is suitably qualified and capable to install, service and remove alcohol interlocks. I declare that the applicant has access to the necessary equipment and support from the Program Manager to perform his or her duties as an Installer or Service Provider and has the appropriate security measures in place to safeguard Personal and Program information and will be trained in the requirements to be adhered to in the relevant state program/s.
NSW/WA/ACT - 3 years QLD/VIC/TAS/SA/NT - 5 years