Transcription of Nominated supervisor consent form NS1 - ACECQA
1 ACECQA , 2017 Nominated supervisor consent formNS01NS01 October 2017 - Page 1 of 11. Approved provider number2. Service approval numberSE-PR-First nameDD/MM/YYYY3. Nominated supervisor contact details:Approved provider nameService approval nameThe date of commencement as Nominated SupervisorDD/MM/YYYYN ominated supervisor DeclarationI, consent to being the Nominated supervisor for (name of education and care service)Signature DatePrivacy statementACECQA and the regulatory authorities are committed to protecting personal information in accordance with the Privacy Act 1988 and the Australian Privacy Principles contained in the Privacy Amendment (Enhancing Privacy Protection)
2 Act provided is being collected for the purposes of assessing this application or notification and may be provided to other authorities or government agencies in accordance with the National , the regulatory authorities and the Australian Government may publish information about you in accordance with the National nameEmailMobile number(Day time)Phone numberDate of birth
