JP type upgrade application form

1. Which state electorate do you live in? * If you are unsure, you can check on this interactive map. Please enter your full address to ensure the result is accurate. —please select— Algester Aspley Bancroft Barron River Bonney Broadwater Buderim Bulimba Bundaberg Bundamba Burdekin Burleigh Burnett Cairns Callide Caloundra Capalaba Chatsworth Clayfield Condamine Cook Coomera Cooper Currumbin Everton Ferny Grove Gaven Gladstone Glass House Greenslopes Gregory Gympie Hervey Bay Hill Hinchinbrook Inala Ipswich Ipswich West Jordan Kawana Keppel Kurwongbah Lockyer Logan Lytton Macalister Mackay Maiwar Mansfield Maroochydore Maryborough McConnel Mermaid Beach Miller Mirani Moggill Morayfield Mount Ommaney Mudgeeraba Mulgrave Mundingburra Murrumba Nanango Nicklin Ninderry Noosa Nudgee Oodgeroo Pine Rivers Pumicestone Redcliffe Redlands Rockhampton Sandgate Scenic Rim South Brisbane Southern Downs Southport Springwood Stafford Stretton Surfers Paradise Theodore Thuringowa Toohey Toowoomba North Toowoomba South Townsville Traeger Warrego Waterford Whitsunday Woodridge
2. Are you applying for a fee waiver? * View eligibility guidelines in the fee waiver form.

   • Yes
   • No
3. 1. * Please upload your completed application for a fee waiver form, as well as the required supporting documents as outlined on the form. Download a copy of the application for a fee waiver form. Attachments must be less than 15MB in total. Approved file types are .doc .docx .pdf .odf .jpg .jpeg .bmp .tif .tiff .png .xls .xlsx
   2. Supporting documents Approved file types are .doc .docx .pdf .odf .jpg .jpeg .bmp .tif .tiff .png .xls .xlsx

   Your file has been attached. We will receive it when you submit this form.

1. * Please attach a copy of your statement of attainment. View an example of a statement of attainment. Attachments must be less than 5MB in total. Approved file types are .doc .docx .pdf .odf .jpg .jpeg .bmp .tif .tiff .png .xls .xlsx  

2. Your file has been attached. We will receive it when you submit this form.

1. Are you applying for an exemption from a disqualifying conviction? * You must apply if you have a disqualifying conviction. Refer to the exemption application form for the definition.

   • Yes
   • No
2. * Please upload your completed application for an exemption from a disqualifying conviction. (If you chose 'Yes' above) Download a copy of the exemption application form. Attachments must be less than 15MB in total. Approved file types are .doc .docx .pdf .odf .jpg .jpeg .bmp .tif .tiff .png .xls .xlsx

Your file has been attached. We will receive it when you submit this form.

1. What is your place of birth?

   1. Town
   2. State
   3. Country *
2. Date of birth * Example: 12/07/1989
3. What is your driver licence number?
4. Are you fluent in another language?

   • Yes
   • No
5. Please specify which language(s) *

1. Are you currently employed? *

   • Yes
   • No
2. 1. What is the name of your employer? *
   2. What is the address of your employer?

      1. Address line 1 *
      2. Address line 2
      3. 1. Town, city or suburb *
         2. State *
         3. Postcode *

1. Title * MrMrsMsMissDr
2. Name

   You must give us your full legal name which matches your identity documents (e.g. your drivers licence).

   1. Given name(s) *
   2. Family name *
3. Are you known by any other names? *

   • Yes
   • No
4. 1. Please list any other names you are known by *
5. Residential address

   1. Address line 1 *
   2. Address line 2
   3. 1. Town, city or suburb *
      2. State *
      3. Postcode *
6. Is your postal address the same as your residential address? *

   • Yes
   • No
7. 1. Postal address

      1. Address line 1 *
      2. Address line 2
      3. 1. Town, city or suburb *
         2. State *
         3. Postcode *
8. What is your preferred contact number? *

   • Home phone
   • Mobile phone
   • Work phone
9. 1. Home phone *
   2. Mobile phone
   3. Work phone
10. 1. Mobile phone *
    2. Home phone
    3. Work phone
11. 1. Work phone *
    2. Home phone
    3. Mobile phone
12. Email * Example: jane.smart@example.com
13. Are you happy for your contact details to be displayed on our website? *

    • Yes
    • No
14. 1. Please provide a reason for your answer *

Please confirm that:

1. Acknowledgement

   * you agree to the Justices of the Peace Branch conducting criminal history and insolvency checks in relation to your application
2. Acknowledgement

   * all details are true and correct
3. Acknowledgement

   * you have read and agree to the privacy statement View the privacy statement
4. Acknowledgement

   * you agree to notify the Justices of the Peace Branch within 30 days of any changes to your contact details, including your name, address, phone number or email address
5. Acknowledgement

   * you permit the Justices of the Peace Branch to make confidential inquiries about your character and suitability for appointment through you nominated referees, any relevant agency and its employees.