This Form Is to Be Completed by an Agency Security Advisor Or Delegate

UNCLASSIFIEDSVA 016

Request for Security Officer Dashboard

Access

This form is to be signed by the nominated security officer and endorsed by an EL2 or equivalent military officer.
All fields are mandatory unless indicated otherwise. / To: Australian Government Security Vetting Agency
Email:
Facsimile: 026127 0034
Mail: Department of Defence - AGSVA CP3-4-075 PO Box 7951 CANBERRA BC 2610

Instructions for completion

This form requests the Australian Government Security Vetting Agency (AGSVA) to provide the person nominated below with the accessto the Security Officer Dashboardrequired to request security clearances and other services from AGSVA.

Section 1Provide details of the security officer who requires access, including the Defence sponsor group and section or DISP company in which they operate.

Section 2To be signed by the nominated security officer member and endorsed by an EL2 or equivalent military officer.

Section 1 – Nominated security officer

Family name / Title
Given names / Date of birth
Email / Security clearance level
Phone
Sponsor Group / Army / Air Force / Navy / DISP Company*
Army Reserves / Air Force Reserves / Navy Reserves / APS Agency*
* DISP Company or APS Agency
Action required / New access request / Cancel access* (New security officer must be nominated below)

*Replacement security officer

Family name / Title
Given names / Date of birth
Email / Security clearance level
Phone
Sponsor Group / Army / Air Force / Navy / DISP Company*
Army Reserves / Air Force Reserves / Navy Reserves / APS Agency*
* DISP Company or APS Agency
Note replacement security officer must be registered with the AGSVA.

Section 2 – Applicant signature and EL2 endorsement

Access to the Security Officer Dashboard is granted at the discretion of the AGSVA. Access is granted on a ‘need to know, need to hold’ basis. Individuals granted access to the Security Officer Dashboard must only access the Security Officer Dashboard, and access, use or disclose data contained on the Security Officer Dashboard in accordance with their duties as a member of the Australian Defence Force, Australian Public Service, or in accordance with the terms of their contract for service with the Commonwealth Government.
Unauthorised access to, use or disclosure of data contained on the Security Officer Dashboard is a breach of the Privacy Act 1988 and may also constitute an offence under section 70 (Disclosure of information by Commonwealth officers), or section 79 (Official Secrets) of the Crimes Act 1914 (Cth).
Criminal or disciplinary action may be taken against an individual for any unauthorised access, use or disclosure under the Crimes Act 1914 (Cth), the Defence Force Discipline Act 1982 (Cth), and / or the Public Service Act 1999 (Cth) respectively.
I
I have read and understood the conditions of access tothe Security Officer Dashboard. I agree to comply with these conditions of access and understand that action may be taken against me for any unauthorised access, use of or disclosure of data contained on the Security Officer Dashboard.
Date / Applicant Signature
Note: Signature is mandatory
EL2or equivalent endorsement
I agree that the person nominated above is required to have access to the Security Officer Dashboard for their security officer duties and authorise the AGSVA to create a profile and logon for them.
Date / Name
Email
Rank/
Appointment / Signature
Note: Signature is mandatory
AGSVA Use Only
VID / CSID / Date actioned
Authorising Officer PMKeyS / Employee ID / Signature
Version: 1.0 May 2014 / UNCLASSIFIED / SVA 016Page 1 of 2