Guardian Interlock Installer or Service Provider Application Form

Select one option only
Select one option only

2. Applicant Details

Relevant Qualifications

mark n/a if not valid
mark n/a if not valid
Service providers please provide brief summary of administration experience

Documentation

In some states there are documents that require a witness signature so these will need to be downloaded, completed and printed to sign then scanned or photos uploaded on the below form.    The links and forms below explain what needs to be done with each form.  If you are waiting on some documents ie. police check you can send this separately once you receive it using this link https://bit.ly/3xOtiqs
Click or drag files to this area to upload. You can upload up to 10 files.
If you are uploading a photo from your phone please ensure the photo is not in LIVE photo mode.

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

NSW/WA/ACT - 3 years QLD/VIC/TAS/SA/NT - 5 years