Additional Access Request Form

ASIC holders requiring additional access to access-controlled areas within Darwin International Airport premises should submit their application using this form.

PART 1 - APPLICANT DETAILS

First Name/s *

Last Name *

Phone Number *

Email *

Company/Employer *

Please upload your ASIC *

Browse

*Accepted format: jpg, png, jpeg, pdf

AUTHORISED COMPANY SIGNATORY DETAILS

Company Signatory Name *

Company Signatory Email *

To check who the Authorising Signatories are for the purpose of Access and Security Control, and avoid any application processing delays, please contact the Terminal Control Centre, Gate A, ground floor | call 08 8920 1822 or email tcc.reception@adgnt.com.au. Applications signed by anyone other than an approved Authorising Signatory will be returned.

INDUCTIONS

Have you completed the appropriate inductions? *

YesNoN/A

SECTION B - APPLICANT CERTIFICATION

I, (Applicant Name) *

Hereby:

(i) confirm that I have read and understood the conditions of issue and use for all DIA Access Control and Access Cards and agree to comply with these conditions;

(ii) acknowledge that I have read, understood and accept the DIA Privacy Statement attached to this application form;(iii) certify that the details contained in this application are true and correct and understand I must contact DIA immediately if any of the information changes.

Applicant Signature *

Draw signature|Type signatureClear

Applicant Signature Date *

ACCESS CARDS - PRIVACY STATEMENT AND CONDITIONS OF USE

PRIVACY STATEMENT

Collection and disclosure to third parties of the information contained within this application form is required in order to enable the processing of Access Control onto your DIA-issued Access Card. The collection and handling of information is in compliance with Division 9 - Aviation Transport Security Act 2004, Part 6 - Aviation Transport Security Regulations 2005, AusCheck Regulations 2007, DarwinInternational Airport Transport Security Program and The Privacy Act 1988.

In addition, we may use your personal information for the purposes of assisting DIA with the correct operation of the airport under various legislation, and in the assessment of any possible security incidents or breaches. Information may also be supplied to third parties in conjunction with any federal investigations.

By submitting this application, you consent to DIA collecting, using and disclosing personal information as set out above.

ACCESS CARD CONDITIONS OF USE AND ISSUE

• Access on the card will expire on the same expiry date as the holders’ current ASIC• Loss of the card is to be reported immediately to DIA Terminal Control Centre – (08) 8920 1822

• The Access Card remains the property of DIA and must be surrendered on expiry, transfer or termination of present duty, or on request by DIA

• The card may only be used in the course of the cardholder’s approved duties in the Secure Areas and does not constitute an authority to enter or remain in a restricted area for any other purpose

• Access on cards is registered for the use of the person to whom it has been issued only

• Incorrect use of access provisions may result in the immediate withdrawal of access privileges. No refund will be granted

• If you have a separate DIA Access Card with Access Control permissions, then these permissions will expire on the same date that your ASIC expires.

• DIA will attempt to reprogram an existing Access Control Card, should the card be deemed damaged or invalid a new Access Control Card will be issued at a cost of $20 in GST

SECURITY AND SAFETY INDUCTION

Before you can have your ASIC or Access Card programmed with access control privileges you must complete the Darwin International Airport Security Induction and NT Working on Airport Induction; this is a mandatory requirement with the objective of keeping Darwin International Airport safe and secure.

If you require access to either, or both of, the Fixed Aerobridge and Apron Drive Aerobridge you must complete the Induction for each type of aerobridge.

The induction is based online and consists of multiple choice questions; all questions have been captured from the Airport Security andSafety Awareness Guide, copies of which are available to download from our website at Access control | Darwin International Airport (darwinairport.com.au) (Working on Airport). Please visit our website and register to sit for the induction. Once you have registered, you will receive an email with your username and password and a link to the induction. Upon successful completion of the induction you will receive an additional email with an attached Training Record; you are required to print and sign the Training Record and bring it with you to the Terminal ControlCentre (Gate A) along with your application form.

I confirm that I have read and understood the Access Card Privacy Statement and Conditions of Use Confirmation, and agree to adhere to all requirements as outlined above by Darwin International Airport. *

I understand that failure to comply with the Access Card Condition of Use outlined above will result in my access permissions being revoked at the discretion of Darwin International Airport. *

AUTHORISED SIGNATORY PRECHECK

Are you an authorised company signatory? *

YesNo

Please click on "Submit" to return this application to the applicant so they can enter the correct signatory details.

PART 2 - TO BE COMPLETED BY EMPLOYER (AUTHORISED SIGNATORY ONLY)

SECTION C - EMPLOYER DETAILS

Company Name *

Company Authorised Signature Name *

Preferred Phone Contact Type *

Work Phone Number *

Mobile Phone Number *

Employer Postal Address *

Street address or PO Box *

City *

State *

Postcode *

SECTION D - ACCESS REQUIREMENTS

Do you need access to critical areas? *

YesNo

*Please see the list of critical areas in the next question.

Please indicate if access to critical areas is required (select all that apply) *

Access Areas Required **Please detail the general as well as critical access areas (if selected above)

Please attach a copy of biosecurity evidence training or DAFF (Department of Agriculture, Fisheries and Forestry) awareness certificate *

Browse

Aerobridge Access: This applies to employees requesting access to operate the control functions of the aerobridges. The employee will be registered to complete the Online Aerobridge Induction.

N/AApron Drive Aerobridge (Bay 1 & 5)Fixed Aerobridge (Bay 2 - 4)All Aerobridges (Drive & Fixed)

Aerobridge Training Log Upload *

Browse

Reason for Access: (You must be specific – justify the applicant’s need to access secure areas by stating actions and duties involved in position) *

SECTION E - EMPLOYER CERTIFICATION

I, (Authrorised Company Signatory Name) *

(i) confirm that the preceding applicant and employer details are correct and that the applicant requires access to the security-sensitive Areas at DIA in order to perform their duties for their employment;

(ii) agree to notify DIA of any changes to the above and to recover and return any DIA-issued Access Card prior to the applicant leaving your employment or upon transfer to a position which no longer has an operational need to retain the Access Card;

(iii) understand that DIA may exercise its right to suspend the production of Access Cards for any company that has expired/unrecovered Access Cards that have not been returned to DIA;

I declare that I am listed as an Authorised Company Signatory. *

Employer Signature *

Draw signature|Type signatureClear

Employer Signature Date *

ROOF ACCESS APPROVAL

Approve and send the application for further approvals? *

YesNo

Declined Reason **This note will go to the applicant, their authorised signatory and DIA Security.

Comment (if any)

Your Name and Position *

Date *

Signature *

Draw signature|Type signatureClear

SERVER ROOM ACCESS APPROVAL

Approve and send the application for further approvals? *

YesNo

Declined Reason **This note will go to the applicant, their authorised signatory and DIA Security.

Comment (if any)

Your Name and Position *

Date *

Signature *

Draw signature|Type signatureClear

PLANT ROOM ACCESS APPROVAL

Approve and send the application for further approvals? *

YesNo

Declined Reason **This note will go to the applicant, their authorised signatory and DIA Security.

Comment (if any)

Your Name and Position *

Date *

Signature *

Draw signature|Type signatureClear

ELECTRICAL WORKS APPROVAL

Approve and send the application for further approvals? *

YesNo

Declined Reason **This note will go to the applicant, their authorised signatory and DIA Security.

Comment (if any)

Your Name and Position *

Date *

Signature *

Draw signature|Type signatureClear

AIRCONDITIONING, REFRIGERATION AND CHILLER UNITS ACCESS APPROVAL

Approve and send the application for further approvals? *

YesNo

Declined Reason **This note will go to the applicant, their authorised signatory and DIA Security.

Comment (if any)

Your Name and Position *

Date *

Signature *

Draw signature|Type signatureClear

SECURITY CONFIRMATION AND APPROVAL.

Is Authorised Company Signatory Valid? (Check SDS) *

YesNo

Detail Declined Reason *

Is access requested within operational requirements? *

YesNo

Authorised Company Signatory Email *

Security Induction Completed Date *

Aerobridge Induction/s Completed (If Applicable)

PACOM Updated *

Security Staff Name *

CAPTCHA *

Save and Complete Later