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SVA 016 UNCLASSIFIED Request for Security Officer Dashboard Access This form is to be signed by the nominated security officer and endorsed by a Commonwealth employee at the level of EL1 or above or a member of the Australian Defence Force at the level of Commander, Lt Colonel, Wing Commander or above. All fields are mandatory unless indicated otherwise. ASA/ASD To: Australian Government Security Vetting Agency Email: [email protected] 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 identified in Section 1 with the access to the Security Officer Dashboard required to request security clearances and other services from AGSVA. This form is also used to advise the AGSVA when a new security officer is replacing an existing security officer. Section 1 Request access: provide details of the new security officer who requires access to the Security Officer Dashboard, including the Defence sponsor group and section or DISP company in which they operate. Section 2 Only to be completed if the new security officer is replacing an existing security officer. Note: The existing security officer being replaced will lose all access to the Security Officer Dashboard upon completion of processing this request. Section 3 To be signed by the new security officer who requires access and endorsed by a Commonwealth employee at the level of EL1 or above or a member of the Australian Defence Force at the level of Commander, Lt Colonel, Wing Commander or above. Section 1 –Details of the new security officer requiring access Family name Title Given names Date of birth Email Security clearance level Phone Army Air Force Navy DISP Company* Army Reserves Air Force Reserves Navy Reserves APS Agency* Sponsor Group * DISP Company or APS Agency Action required New access request *Section 2 – Details of the existing security officer being replaced and removed* (only complete if relevant) Family name Title Given names Date of birth Email Security clearance level Phone Army Air Force Navy DISP Company* Army Reserves Air Force Reserves Navy Reserves APS Agency* Sponsor Group * DISP Company or APS Agency *Note the existing security officer to be replaced and removed must be registered with the AGSVA. Version: 1.2 May 2017 UNCLASSIFIED SVA 016 Page 1 of 2 SVA 016 UNCLASSIFIED Request for Security Officer Dashboard Access ASA/ASD Section 3 – Applicant signature and 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. II have read and understood the conditions of access to the 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. Applicant Signature Date Note: Signature is mandatory EL1, Commander, Lt Colonel, Wing Commander (or above) 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/title Signature Note: Signature is mandatory AGSVA Use Only VID / CSID Authorising Officer PMKeyS / Employee ID Version: 1.2 May 2017 Date actioned Signature UNCLASSIFIED SVA 016 Page 2 of 2