Statement
I am not the subject of disciplinary proceedings in any State (including any preliminary investigations or action that might lead to disciplinary proceedings) in relation to those occupations; and
My registration (including interim deemed registration and automatic deemed registration) in any State is not cancelled or currently suspended because of disciplinary action; and
I am not otherwise personally prohibited from carrying on any such occupation in any State and is not subject to any conditions in carrying on that occupation, as a result of criminal, civil or disciplinary proceedings in any State.
Declaration
I have read and understood the Statement above and submit this for the purpose of providing a notification under Automatic Mutual Recognition scheme.
Note:
On the acceptance of the notification, the duration of the notification will be for the same period as provided by the home or principal place of work registration. There is no need to re-notify for every working visit to Tasmania within this time frame.