Office Use Only: Registration #

EC40 .

Application for a Limited Authority to

 Please refer to the LAT policy on our website to
ensure you are eligible to apply.

Teach (LAT)
Use the EC40 Completion Guide provided to help
you fill out this form.

Section A: Personal details  Applicant to complete

This section needs to be completed along with the proof of identity section on Page 2. Refer to the EC40 Completion Guide for further information.
1 Identifying details
Surname or family name:

First and middle name(s):

Are you known by or have you used any other names?:

Title: Select one If other:
Date of birth:
Gender: Select one If other: (dd/mm/yyyy)

Nationality: Place of birth:

NZ driver licence number:

2 Contact details
Home address:

Postal address: (if different)

Home phone: Mobile phone:

Other phone:

Email address: (personal recommended)

Alternative email address: (used if first fails)

3 Are you currently employed? Select one If yes, provide details:
Name of learning centre: Learning centre MOE #:

Address: Start date:

Previous LAT applications for this position? Select one If yes, in which years?

Section B: Payment details  Applicant to complete GST # 116-961-962

4 Fee payment: The Education Council must have the full fee payment before we will begin processing your application.
[ ] Cheque - Cheques payable to: Education Council [ ]
Credit/debit card, to be charged as per the following details: Select one

Cardholder name:
Card number:
Expiry date:
Cardholder signature:
Fee schedule (non-refundable). I authorise you to deduct the fee as below:
The fee that applies will be determined by the date the application form and payment are received by the Education Council.
Fees including GST 15%
[ ] 1 year LAT [ ] $56.22 for up to 1 year
[ ] 2 year LAT* [ ] $112.44 for up to 2 years*
[ ] 3 year LAT* [ ] $168.66 for up to 3 years*
[ ] Late fee if applicable (see Completion Guide) [ ] Late fee $50 if applicable
*Specific criteria need to be met for 2 and 3 year LAT.
Form EC40, Version (2018-08-01) Physical Address: Postal Address:
Level 7, 80 Boulcott Street PO Box 5326
Page of 1 of 6 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Proof of identity  Principal, Centre Manager or ITE Head of Programme to complete
The applicant is not required to provide any certified copies of the identification documents to the Education Council. If you are living overseas
(not in New Zealand) at the time of completing this form, you will need to use the overseas form found here.
Surname of applicant
First and middle name(s) of applicant
Select the two forms of identification \RXZLOOSUHVHQW. You must present the RULJLQDOdocuments to the identify referee. One form
of identification from Category A and one from Category B (refer to dropdowns below). At least one of the acceptable forms
of identification must be photographic.7KHGRFXPHQWVPXVWEHRULJLQDOVFXUUHQWDQGQRWH[SLUHGDQGLVVXHGE\DQDXWKRULVHG
DJHQF\DVRXWOLQHGLQWKH&RPSOHWLRQ*XLGH
Category A (select one)

Category B (select one)

Document name Document number Issue date (if applicable) Expiry date (if applicable)
Category A Category A (select one)
Category B Category B (select one)
Name change
Please select
(if applicable)

ID Referee details
The ID Referee must be either a6FKRRO3ULQFLSDO(&(&HQWUH0DQDJHUor,7(+HDGRI3URJUDPPH
Please confirm which of the above positions you hold:
Teacher registration number (if applicable):

Name of identity referee:

(full name)
Name of learning centre:

Address:

Contact number:

ID Referee to complete
Identification documents presented to you in person by the applicant must be the one document from Category A and one
document from Category B. The documents must be originals, current and not expired and issued by an authorised agency as
outlined in the Completion Guide. If applicable, where names or other identity information are different on either document
(Category A and B), please confirm you have sighted acceptable evidence of name change (a Marriage Certificate is acceptable
but a Particulars of Marriage is not). See Completion Guide for more information and the full list of acceptable identification
documents.
You must apply an official
school/centre stamp or seal

By my signature below, I confirm that I have sighted two forms of identification (one from
Category A and one from Category B) and I verify that the person in the photo is the
person whose name is printed in full above.

Name Change: I have sighted evidence of the name change (identity referee tick if
applicable) and I have attached a certified copy of the name change document to this
form.
STAMP
Identity referee’s signature Date

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 2 of 6 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Section C: Education  Applicant to complete.
5 Qualifications - Attach certified copies of all qualifications and transcripts of the qualifications listed.
Length of Year
Qualification name Institution Location
course completed

Continue on a separate sheet if necessary.

6 NZQA Assessment report
If you completed any of your qualifications outside New Zealand, you will need to have a New Zealand Qualifications Authority
(NZQA) assessment report of your qualification/s. If you have applied to NZQA, please write your NZQA application number below. If
you have not applied to NZQA please make an application now.

NZQA Application Number

Section D: Experience  Applicant to complete.

7 Please list employment completed within the last five years relevant to the area you want to teach in and attach a copy of your CV.

Position/role Place of employment Location From To Relevance to learners within the

(MM/YY) (MM/YY) general education system

Continue on a separate sheet if necessary.

Section E: Purpose of application  Applicant to complete.

8 Please select one of the following.
I am applying for a LAT on the grounds that:
[ ] I have skills and experience appropriate to advance the learning of students.

[ ] I have skills that are in short supply.

Evidence provided

I have attached testimonials and self-reflection OR a copy of my most recent appraisal in a teaching position (see Completion
Guide for guidance about this).

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 3 of 6 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Section F: Time spent outside of New Zealand  Applicant to complete.
See the EC40 Completion Guide for detailed instructions on completing this section.
9 Overseas police certificates
(a) Have you spent 12 months or more in any country other than New Zealand in the last 10 years?
[ ]
Please select Yes or No
(b) Please list the countries you have been in for 12 months or more in the last 10 years other than New Zealand.
Country From (MM/YY) To (MM/YY) Police certificate: Attach certified copies of all police certificates listed.
Choose one of the options*: Select one
Date (if ‘applied for’ or ‘provided on’):
Choose one of the options*: Select one
Date (if ‘applied for’ or ‘provided on’):

Continue on a separate sheet if needed.

*Options are: 'attached'; 'Applied for on'; 'Provided to the Educational Council on'.

Section G: Language proficiency  Applicant to complete.

See the EC40 Completion Guide for detailed instructions on eligibility criteria and documents to attach for this section.

10 Official languages of New Zealand (you must tick at least one to be eligible for a LAT)
You need to select one of the following to show language proficiency in English or Māori.
English/Māori is my first spoken language and instruction medium in all schooling and qualifications (attach specified documents). [ ]

English/Māori language test (attach certified copies of test).

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 4 of 6 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Section H: Applicant Declaration  Applicant to complete
11 Declarations - complete each of the questions below by ticking the boxes.

Have you ever been dismissed from a teaching position in any country? Please select Yes or No

Have you ever had teacher registration refused or cancelled in any country? Please select Yes or No

Do you have any physical or mental health condition that may affect your ability to carry out a Please select Yes or No
teaching role safely and satisfactorily? *

Are there any matters for which you are currently under investigation which may call into question
Please select Yes or No
whether you meet the Education Council's Good Character and Fit to be a Teacher criteria?

* The Council will distinguish between any mental or physical condition that affects an applicant’s ability to carry out the teaching role satisfactorily and any disability that
an applicant has that does not impact on that ability. The Council is aware of its obligation not to contravene the Human Rights Act 1993 by unlawfully discriminating
against any person.
12 Explanations of “yes” declarations
You must attach details of any YES answer to Question 10 above. See the EC40 Completion Guide for detailed instructions.

13 Acknowledgements and statement of consent

 I, (surname)

(first name/s)

solemnly and sincerely declare that, to the best of my knowledge and belief, all the information in this application is entirely true
and correct.
 I confirm that I can speak lucidly and write clearly in an official language of New Zealand.
 I confirm that I am committed to upholding the Code of Professional Responsibility for Certificated Teachers.
 I understand that the Education Council will retain the information I provide on and with this application for the purposes of the
Education Act 1989.
 I consent to the Education Council sharing and receiving relevant information with other education agencies and registration
bodies for the purposes of this application and as registered or authorised teacher.
 I consent to the disclosure of the information contained in this form to the following organisations as required, for the purpose of
processing my application:
 Ministry of Education (and their pay agents)
 New Zealand Qualifications Authority (NZQA)
 Education Review Office (ERO)
 New Zealand Immigration Service
 New Zealand Police
 International registration bodies.
 I have read and understood the Consent for Disclosure for a Police vetting check (see Section G in the Completion Guide)
 I understand that if I have been convicted of a Specified Offence as defined in section 23 (1) of the Vulnerable Children Act 2014
this will be disclosed by New Zealand Police.
 I, the above-named, hereby consent to the disclosure by the New Zealand Police of any information that they may have pursuant
to this application to the Education Council. I understand that any record of criminal convictions I might have will automatically be
concealed if I meet the eligibility criteria stipulated in Section 7 of the Criminal Records (Clean Slate) Act 2004.
 I understand that the Education Council may contact institutions or individuals named in this application to verify the information
provided.
 I accept that the Education Council may use any of the information on this form for statistical purposes, within the obligations and
requirements of the Privacy Act 1993.

14 Signature

Signature: Date signed:

Please ensure that the declaration form has the following sections completed correctly:
(1) G10 Each checkbox has been ticked.
(2) G12 Applicant name is printed and can be clearly read.
(3) G13 Declaration has been signed.
(4) G13 Declaration must be dated within the last three months from the day the form is received by the Education Council.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 5 of 6 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
 Section I: Professional leader endorsement  Professional Leader to complete
Endorser should complete this section only after the applicant has completed all sections.
15 Endorsement statement
I confirm that the applicant:
(surname)

(first name/s)

is of good character and fit to be a teacher and

(please complete either question 15a or 15b)

15a
 has specialist skills and experience appropriate to advance the learning of students; and
 their specialist skills are:
(text will automatically shrink)

 and their teaching

subjects will be:

And

 I have sighted and endorsed their self-reflection.

OR

15b

 their specialist skills are:

(text will automatically shrink)

 and their teaching

subjects will be:
and
 there is a shortage of certificated teachers with these skills in my region.

And

 I have provided an evidence-based testimonial attesting to the skill shortage in this region.

15c The intended start date is:

16 Endorser details
I am the professional leader, and I agree to my registration number and name being published
on the LAT list on the Council’s website as the endorser of the above named person.

Full name:

Learning centre:

Registration number: Position/Role:

Signature Date signed:

(print and sign):

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 6 of 6 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
EC40 Checklist

PAGE 1:

All parts of section A are completed correctly – please ensure you include in full your surname or family name and first and
middle names.

If you are paying by credit card please ensure all credit card details have been provided on the form.

If you are eligible for payment under the collective agreement please ensure you download the exemption form from the
Council website and include the completed form with this application. NOTE: the late fee of $50 is not covered under the
collective agreement; if the late fee is applicable to you, please include credit card details and tick the late fee box.

Attach payment, a correctly completed collective agreement exemption form and/or provide credit card details.

PAGE 2:

All sections of the proof of identity form is completed correctly (current ID document numbers, dates if applicable have been
included in the table provided).

Identity referee is approved by the Council and has provided full name, contact details, signature, date and stamp, and
answered the questions by ticking appropriate boxes.

PAGE 3:

Qualification details are listed and certified copies are attached. If applicable, provide NZQA assessment report or NZQA
application number.

All employment relevant to LAT application including start and end dates in the last five years have been provided.

You must provide a reason for applying for a LAT

Self reflection and Testimonial are attached. If renewing, then a copy of your most recent appraisal in place of the self-
reflection.

PAGE 4:

You must provide a YES or NO answer for the Time spent outside of New Zealand section.

PAGE 5:

Each box is ticked.

Declaration must be dated within the last three months from the date the application is received by the Council.

Declaration is signed and dated.

PAGE 6:

Endorsement section has been signed and completed correctly.

CHECKLIST CONTINUES ON NEXT PAGE

Form EC 40, Version (2018-08-01) ) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
 Ensure these pages have been physically signed and dated:

Page one (if paying with credit card – signed by the card holder).

Page two (proof of identity – signed and dated by ID referee).

Page five (Applicant declaration – signed and dated by applicant).

Page six (Endorsement – signed and dated by professional leader).

Form EC 40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
 EC40 Completion Guide
Access and Print the completed Attach the fee Attach any additional You will be sent an
complete the EC40 form and sign and payment or attach the documents required acknowledgement
application form date relevant Collective Agreement and post/courier to the upon receipt of the
sections E[HPSWLRQ form Education Council application form
online

Once approved, you We will communicate

will be notified by Contact us if you have with you by email or Our standard processing
email, post & online had no contact within post if more time is six weeks
via the register four weeks information is required

About this form

How to use this guide
This guide aims to help you fill out the EC40 form correctly. While you complete the form, have this guide open at the relevant
question. (Each question on the form is explained with the same number in this guide.)
This makes sure you give the Education Council of Aotearoa New Zealand (called the Education Council on this form) the right
information the first time, so we can process your application quickly and accurately. If you write the wrong details, leave information
out, or fail to provide the required documentation, processing your application is delayed while we contact you.
The Education Council requires the documents you provide to be in English. If your documents are not in English or Maori, you must
provide a translation from an official service, as well as the certified copy as described in this guide.
Note: In this form and guide, the phrase “learning centre” is used to mean schools and kindergartens in which you can be employed
in a teaching position with a LAT.
When to use this form
You can only apply for a Limited Authority to Teach (LAT) if the following criteria apply to your situation:
• You are not a registered and certificated teacher and are not eligible to become one.
• You have been offered a temporary teaching position in a school or kindergarten for a specific period.
• The employer has tried, but cannot find a certificated teacher to fill the position.
• The role has clear expectations involving the standard teaching activities with the person for this position having prime
responsibility for planning, assessing, reporting and evaluating a group of students.
• You are of good character and fit to be a teacher.
• You have the skills and experience to be likely to be a satisfactory teacher for a teaching position.
When not to use this form
• Do not use this form if you are seeking registration and/or certification as a teacher in New Zealand. You can download the
correct forms from the Education Council website.
• Do not use this form if you are (or have been) eligible for a teacher’s practising certificate. If you are eligible in relation to your
teaching qualifications for a practising certificate, you are not eligible for a LAT. Instead, contact the Education Council.
• Do not use this form for a teacher aide or non-teaching role or if you are employed in any other type of support role such as, as a
kaiarahi i te reo or kaiawhina. You do not need authorisation from the Council when you are employed and paid in a support role.
Important facts about LATs
Before applying for a LAT, you need to know the following information:
• A LAT is granted to you and cannot be transferred to another person or to another type of teaching position. It relates:
 only to you
 performing only the role described,
 for only the situation or location shown, and
 during only the time period listed.
• A LAT is not a type of teacher registration or practising certificate; it is a separate category of authority to be employed in a
teaching position in New Zealand. Under Section 349 of the Education Act 1989, employers in the general education system are
only allowed to employ you in a teaching position if you have either a practising certificate (for which you must be registered) or a
LAT.
• Until you have a LAT, a school or kindergarten is only permitted to employ you for up to 10 days (20 working half–days), and a
certificated teacher must supervise you during that time. If you cannot obtain a LAT before the 10 day limit expires, the school or
kindergarten needs to apply to the Education Council for an extension to that limit, explaining why it is needed. For an extension
to be issued, the Education Council must be processing the application and have all fees paid.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 1 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
About this form (continued)
Writing notes on the form
If you think we might find any answer unclear and you want to clarify it, you can write notes on the form.
Where to go for more information
If you have any questions about completing this application, visit the Education Council website www.educationcouncil.org.nz. If you
cannot find the information that you are looking for, phone the Education Council. When enquiring by phone or mail, please give
your full name and either authorisation number or date of birth, so that we can identify your record.
Originals, copies and attachments
You must send this form as the original. The Education Council cannot approve faxed or photocopied applications. The Council will
not return any original documents, so please send us certified copies only.
A certified copy is a copy of the document that has been verified by an official such as:
• School principal / Centre manager • Justice of the Peace
• Solicitor • Registrar, or
• Notary public • The authority who originally issued the document.
The person certifying the documents must note on every page the following “certified true copy of the original” and must clearly
identify and include on the document: [full name of official] [signature of official] [title] [address and contact number] [official
stamp or seal] [date the documents were certified]. If the Education Council is not satisfied with the certified documents that you
have provided, you may be asked to provide further documentation or for the documents to be certified again.
Do not send:
 a copy of a certified copy
 original documents (the Education Council does not return them).

Completing Section A: Personal details

This section collects the details that identify you from other applicants and allows the Education Council to contact you if needed.
Please send updates to the Education Council when any of these details change. There is a web form on our website that you can
complete to submit changes at any time. This section of the application also forms part of the requirements around proof of identity, which
is further outlined in this guide under the section header Completing proof of identity.
1 Identifying details
Please complete this section thoroughly. This will ensure we can communicate with you and that the NZ Police can process their
check quickly and efficiently. Complete your name in the fields provided. In “other names used”, give any other names by which you
have been known, or that appear on any documents that you are attaching to the application, e.g., a maiden name. Birth date and
gender are used to make sure we do not mix up your records with those of another person who has the same name. The New
Zealand driver licence number should be used where applicable.
Changes to identity information
If the name on your qualification(s) is different from your legal name or if you have changed your name or identity information since
you last applied to the Education Council, you must provide a certified copy of your official name change document.
• Acceptable evidence of changes to identity information is listed in this guide in the table called Category C: Evidence of changes to
identity information. See guide notes for Completing proof of identity.
• Please refer to the notes in this guide under the section header Originals, copies and attachments for specific information on how
to certify the documentation needed.
• If there are inconsistencies across the identification documents or identity verification you have provided to the Education Council
you may be asked to provide further information.
2 Contact details
This information gives us ways to contact you about your application and helps us keep our records up to date. If providing an email
address, please make sure it is an email address that is personal and permanent. If given we will use email contact first. It is
important that you contact the Education Council with any changes to these contact details at all times. We will send
communications by post to those whose email address bounces or when no email address is provided.
3 Your employment
To be employed in a teaching position, you are required to hold a current practising certificate or authorisation from the Council. It is
unlawful to be employed in a teaching position in a school and most teaching positions in the ECE sector without a current practising
certificate or authorisation. If you have already commenced employment, you will need to provide your employment details in this
section. The Education Council will consider this information as part of the processing of your application. If you have been offered a
teaching position and have not yet started, this information should also be provided. Please note, a LAT is available only for a
temporary position.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 2 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Completing Section B: Payment details
4 Fee payment
You can pay the required fee using one or a combination of methods. Do not send cash. This fee is non-refundable. If the
information provided is sufficient to make the decision to approve or decline an application, the Education Council will make this
decision. It is therefore important that all specific requirements have been met at the time of applying. If more information is required,
it is expected that this is obtained promptly and sent to us. Please keep us informed about any difficulties or delays. We would
usually only keep an application open for these reasons for up to six months.
Late fee
A late fee is payable if you do not have current authorisation from the Council and you are employed in a teaching position that
requires you to hold one when we receive your application.
Fee schedule (non refundable). Important: No authorisation without payment
This document is an application to apply for a Limited Authority to teach (LAT). The Education Council must have the full amount of
your fee payment before we will begin assessing your application. Your application for a LAT is not approved until you are formally
advised. If any problem arises with your payment (such as dishonour of a cheque or credit card transaction), we will contact you.
Please ensure you attach the full payment, and be certain that any cheque or credit/debit card account you provide has sufficient
credit for the transactions, and will not expire for at least a month from when you submit the application. The fee schedule on the
latest version of the application form outlines the amount required to be paid. If paying by credit/debit card we will deduct the fee
applicable at the time of receipt.

Completing proof of identity section

The Education Council requires the identity referee to be either a School Principal, a Centre Manager of an early childhood education
centre or an ITE Head of Programme. If you are applying from overseas, download the overseas POI form found on this web page.
The identity referee must:
• verify the two forms of identification required in this section (one from Category A and one from Category B) of which one form of
identification must be photographic
• verify that the applicant, who must also be the presenter of the identification documents, is the same person as identified in the
document Category A and Category B
• complete all sections of the form and apply the school/centre stamp or seal
• not be related to, or be a partner or spouse to the applicant
• not reside at the same address as the applicant
• be living in New Zealand and have an accessible contact address and telephone number.
Identification verification
• The applicant must provide in person two forms of identification documents to be certified by an acceptable identity referee.
These must be original documents.
• They must include one “Primary identification document/record” and one “Secondary identification document/record” issued by
an approved agency. See Category A and B in the table below.
• One identification document from either category A or B must be photographic.
Category A: Primary identification document/record Issuing agency
New Zealand Passport Department of Internal Affairs
New Zealand Certificate of Identity issued under the Passports Act Department of Internal Affairs
1992 to Non-New Zealand citizens who cannot obtain a passport from
their country of origin
New Zealand Certificate of Identity (issued to people who have Ministry of Business, Innovation and Employment
refugee status) (Immigration New Zealand)
New Zealand Refugee Travel Document Department of Internal Affairs
Emergency Travel Document Department of Internal Affairs
New Zealand Firearm Licence New Zealand Police
Overseas Passport (with or without New Zealand immigration Relevant Authority in country of issue (visa/permit
visa/permit) to be issued by Ministry of Business, Innovation
and Employment (Immigration New Zealand))
New Zealand Full Birth Certificate issued on or after 1998 Department of Internal Affairs
New Zealand Citizenship Certificate Department of Internal Affairs
Category B: Secondary identification document/record Issuing agency
New Zealand Driver Licence New Zealand Transport Agency
18+ Card Hotel Association of New Zealand
Community Services Card Ministry of Social Development
Super Gold Card Ministry of Social Development
Veteran Super Gold Card Ministry of Social Development
Inland Revenue Number Inland Revenue Department
Electoral Roll Records Ministry of Justice
New Zealand utility bill, issued not more than six months earlier Power/telephone company

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 3 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Completing proof of identity section (continued)
Evidence of name change or other changes to identity information
It is important that the evidence of identity presented to the identity referee covers all identity information provided in the sections of
the application form under the headings of Personal details, Applicant declaration and Proof of identity.
If the identity documentation that you provide to the identity referee shows that there is a difference in the name or other aspects in
the identity related information that those documents were issued under, you will need to provide to the identity referee evidence
from the table below in Category C to verify the difference. For example if the document that you provide to the identity referee from
Category A was issued under a name that is different from the name that the document you provide from Category B, you will need
to provide a document from Category C that verifies that difference in name for both documents. Note: If there are inconsistencies
across the identification documents or identity verification you have provided to the Education Council, you may be asked to provide
further information.
Category C: Evidence of changes to identity information Issuing agency
Change of Name by Statutory Declaration Department of Internal Affairs
Change of Name by Deed Poll Department of Internal Affairs
New Zealand Change of Name Certificate Department of Internal Affairs
New Zealand Marriage Certificate (not Particulars of Marriage) Department of Internal Affairs
New Zealand Civil Union Certificate Department of Internal Affairs
New Zealand Birth Certificate issued on or after 1998 Department of Internal Affairs
New Zealand Divorce Papers Ministry of Justice
Certificate of Annulment Ministry of Justice
Overseas Passport Relevant authority in the country of issue
Overseas Birth Certificate or Overseas Marriage Certificate Relevant authority in the country of issue

Completing Section C: Education

The Education Council generally requires that a person applying for a LAT has qualifications in a specialist subject area that are at least
at Level 6 on the New Zealand Qualifications Framework. If you do not have qualifications or if they are at a lower level, the Education
Council will place greater weight on your relevant experience, self-reflection and testimonials attesting to your skills and experience when
determining whether or not you meet the requirements to be granted a LAT.
5 Qualifications
List your completed qualifications, the institution from which you gained them, the country as well as the town, city or area and the
year which you completed them. Please attach certified copies to the application for all the qualifications and their associated
transcripts that you list here.
6 NZQA Assessment Report
The Education Council requires you to provide a certified copy of an NZQA International Qualifications Assessment (IQA) that has
been issued by NZQA within the last 5 years if your qualifications were completed overseas. If you have applied to NZQA for this
IQA but have not yet received it, please enter your NZQA Assessment Application number. If you have not applied to NZQA, please
make an application now www.nzqa.govt.nz.

Completing Section D: Experience

This section collects details of any teaching experience you already have.
7 Teaching Experience
Column Description
Position/role Give the title and brief description of position held.
Place of employment Give details of where you worked and the relevant work experience linking these to the subject area
and the scope of practise within which you wish to teach.
Location Give the town or city and country where your employment was based.
From/To Give the month and year when your employment in this position began and ended.

Recent employment or experience should be directly relevant to the subject area in which you intend to teach, and be linked to your
specialist qualifications. Please provide a brief note indicating the relevance of your employment or experience to learners you intend to
teach within the general education system.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 4 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Completing Section E: Purpose of application
8 Purpose of application
You are required to provide a self-reflection linking your qualifications or training, recent employment or experience and their
relevance to learners in the area in which you intend to teach. Testimonials should also be provided from any employer or person
who has engaged you to deliver your specialist skills (this may include within a volunteer or community capacity) in the last five
years. Testimonials must be on letterhead and be signed and dated.
Purpose of application Information required in self-reflection Information required in testimonials
Skills and experience You will need to demonstrate that you have an Testimonials will need to attest to:
appropriate to understanding of:
advance the learning a. your skills and how they were demonstrated in
of students a. official curricula in the area you want to teach; your practice
and
b. your understanding of official curricula and
b. appropriate assessment tools and strategies assessment tools (where relevant) and how this
for the sector you want to teach in. was demonstrated within your practice.
Your self-reflection should also detail the
relevance of your specialist qualifications and/or
recent experience to learners within the general
education system.
Skills that are in short You will need to: Testimonials will need to attest to your skills and
supply how they were demonstrated in your practice.
a. outline your skills and experience and how
they are relevant for learners within the general You must provide at least one testimonial from the
education system; and professional leader of a school or kindergarten in
the geographic area in which you want to teach,
b. include a brief explanation about why your attesting to the shortage of your particular skills
skills are in short supply. amongst registered and certificated teachers.

Completing Section F: Time spent outside of New Zealand

9 Overseas police certificates
Regardless of your nationality, you must obtain a police certificate from any overseas country (a country outside New Zealand)
where you have lived for 12 months or more within the last 10 years. The police certificate must cover the entire period in which you
have lived in the country and must be a national certificate.
(a) Tick “No” only if you have never lived for 12 months or more in any one overseas country in the last 10 years (e.g., if you
have always lived in New Zealand and have never travelled overseas for more than a few months holiday at a time).
(b) Tick “Yes” and list the countries then tick the box that applies.
NB: If you have provided a police certificate with an earlier application to the Education Council, you only need to
provide a further certificate for that country if you have been back there for 12 months or more since the approval
of your last application.
Include all countries where you have lived for 12 months or more within the last 10 years, regardless of whether:
 you were living there, travelling around, working or on holiday
 (if you have immigrated to New Zealand) it was your “home country” or a country you were only visiting
 you needed a visa to enter New Zealand from there or not (e.g., immigrants from Australia still need to list Australia)
 you lived in one or in several places within the country (as long as the period totalled 12 months or more).
Do not include any time overseas while you were under the age of 16.
Important! Certificates take time
If you have applied for a certificate, but not yet received it, please give the date you requested it in the space provided.
It is important to apply for police certificates as early as possible. Some countries take up to several months to process a
request. We expect you to take reasonable steps to obtain these as early as possible. Your application could be closed if we
receive no response to efforts to contact you or you are not showing attempts to complete this requirement and gain the
necessary police certificate.

(Continued overleaf …)

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 5 of 9 Wellington 6011 Wellington 6145
Telephone: (04) 471 0852 [email protected]
Completing Section F: Time spent outside of New Zealand (continued)
How to obtain certificates
You need to apply to the relevant agency in each country. Each agency has its own forms to use and provisions for issuing police
certificates. Most countries charge a fee to provide these documents, which you are responsible for paying.
This table shows the most commonly visited countries, and how to request a police certificate from there:
These address details were accurate at the time of the version date of this form. See the date at the bottom of the form.
Country Where to apply What to request
Australia Apply to Australia Federal Police, Criminal Records, Locked Bag A National Police Certificate
8550, Canberra, ACT 2601, Australia. Request a National Police should be a “Complete
Check and ensure you enter Code Number 21. We require a Disclosure". We will accept
‘Complete Disclosure’ check. If you receive a ‘Partial Disclosure’ or a declaration in combination
‘Standard Disclosure’ check, please contact us at with your Partial or Standard
[email protected] and ask for a statutory declaration Disclosure check.
to complete. See the Australian Federal Police website.
Canada Apply to your local police agency and request a check against the Royal If possible, please request a
Canadian Mounted Police (RCMP) or Canadian Police Information Vulnerable Sector Check.
Centre (CIPC) database. Website: www.rcmp-grc.gc.ca

Fiji Officer in Charge, CID, Police Headquarters, Suva, Fiji A police certificate to be
forwarded direct to the
Education Council (Give our
postal address)
Ireland (Eire) From outside Ireland: Police certificate of good
Chief Superintendent Liaison and Protection Garda Headquarters, character
Phoenix Park, Dublin 8, Ireland
From Ireland:
In person to your local Garda station
Website: www.garda.ie
Japan From NZ: “No Criminal Record
Embassy of Japan, PO Box 6340, Wellington Certificate” (NCRC), “Police
From Tokyo: Clearance” (Keisatsu
Tokyo Public Safety Division, Metropolitan Police Department, Shomeisho, Hanzai Keirei
2-1-1, Kasumigaseki, Chiyoda-Ku, Tokyo Shomeisho or Muchanzai
From elsewhere inside Japan: Shomeisho)
Your local Prefectural Police Office
Singapore Request a ‘Certificate of No Criminal Conviction’ (CNCC). Please note: Certificates of
No Criminal Conviction are
From Singapore, apply in person at the CNCC Office, Police only issued to citizens of
Cantonment Complex, Blk D#02-01A, 391 New Bridge Road, Singapore. Non-citizens will
Singapore 088762. need to contact the
Education Council to
From New Zealand, contact the Singapore High Commission, 17 request an overseas police
Kabul Street, Khandallah, Wellington, New Zealand. certificate letter.

See the Singapore Police Force website for more information

South Africa The Commissioner, Criminal Bureau, Security Branch, South African A South African Police
Police, Private Bag 308, Pretoria 0001, Republic of South Africa Clearance Certificate
United Kingdom Apply to the Association of Chief Police Officers (ACRO), P O Box 481, An International Child
(including Fareham, PO14 9FS, UK for an International Child Protection Certificate. Protection Certificate
Northern Website: https://www.acro.police.uk/icpc/
Ireland) Please note: We may accept standard or enhanced disclosures issued
through Disclosure Scotland if this has been issued for teaching
employment. However, the disclosure must cover the entire period of
time you were living in the UK.
United States of Federal Bureau of Investigation, Identification Division FBI identification record
America 1000 Hollow Custer Road, Clarksburg, West Virginia 26306
Website: https://www.fbi.gov/services/cjis/identity-history-summary-
checks
For other countries, we recommend the following sources to identify the relevant authority to contact:
• the police in the relevant country
• the diplomatic office (embassy, high commission, etc.) in New Zealand for that country.
If none of these sources provide the information you need, contact the Education Council.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 6 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
 Completing Section G: Language proficiency
10 Official NZ languages
To be eligible for a LAT, you must be proficient in at least one of the official languages of New Zealand (English or Māori).
Option Description
English/Māori is your first You are considered proficient in English/Māori if:
spoken language and • English/Māori is your first spoken language and
medium of instruction in all
schooling and • English/Māori has been the medium of instruction in all primary and secondary schooling (Evidence
required)* and
qualifications
• all schooling qualifications have been completed in English/Māori.
*Evidence will be in the form of a written statement from the institution(s) confirming English/Māori was the medium
of instruction and that all schooling qualifications were completed in English/Māori.
English/Māori language Tick this box if you have completed one of the listed English/Māori language tests and attach a certified copy of the
test test result certificate.
The minimum scores are required for all four of the modules, macros skills or components of the courses: reading,
writing, listening and speaking. You do not have to achieve this score in a single sitting. You can re–test to achieve
the required minimum standard and need only meet the standard in areas previously not met.
English / Māori language tests
Test name Minimum score required
International English Language Testing System (IELTS) Academic Version. Seven for each component.
Web site: www.ielts.org
International Second Language Proficiency Ratings (ISLPR) Four in all modules
Certificate of Advanced English (CAE) A minimum score of 185, with no score less than 185.
Certificate of Proficiency in English (CPE) A minimum score of 185, with no score less than 185.
NMLPT / Whakamātauria Tō Reo Level Four

Completing Section H: Applicant declaration

This section asks for your personal confirmation that you are of good character and fit to be a teacher and that you accept the terms of
the application.
11 Declarations
You must tick one response box for each of these questions.
Consequences of false declarations
If the Education Council finds you have knowingly declared false information on the EC40 form, you may be prosecuted and fined up
to $2,000, and your LAT may be cancelled.
12 Explanation of “yes” answers
If you tick any of the “Yes” answers to Question 10, you must attach a separate sheet that explains the situation(s) involved,
including any details relevant to your application, for example, key dates or any resolution.
Question How to answer
Dismissed Give a clear explanation of the circumstances surrounding your dismissal from a teaching position.
Registration/authorisation This covers any category of authority to teach (such as “registration”, “licensing”, or “classification”)
cancelled/refused relevant in the applicable country, including limited authorities to teach.
Medical condition * List all physical and mental health conditions that are relevant to your ability to carry out teaching
duties. Appropriate information to provide includes:
• severity of the condition, and whether it is acute (short term) or chronic (ongoing)
• frequency and duration of episodes when it could impact on your teaching
• general details of treatment received (particularly if this is ongoing)
• (if applicable) progress made toward recovery, and expected timeframe for full recovery.
You may be requested to supply a medical certificate and/or endorsement from your professional
leader commenting on your fitness to teach.
Any other matters** Provide this information or the details of any matter(s) in writing. Give a clear written explanation of any
matter(s) that may call into question whether or not you meet the Education Council’s Good Character
and Fit to be a Teacher criteria.
* The Education Council will distinguish between any mental or physical condition that affects an applicant’s ability to carry out the teaching role
satisfactorily, and any disability that an applicant has that does not impact on that ability. The Education Council is aware of its obligation not to
contravene the Human Rights Act 1993 by unlawfully discriminating against any person.
** Tick “Yes” if your employing body, the professional/registration body where you are registered (or where you were previously registered), the
police or another government agency has begun an investigation. If you are unsure about what you need to disclose, contact the Education Council.

(Continued overleaf…)

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 7 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Completing Section G: Applicant declaration (continued)
13 Acknowledgements and statement of consent
Please complete your name as proof that you have read and accepted the statements in this section. The Education Council will
proceed with processing your application within these terms.
The Education Council requests a “vetting” check from the NZ Police and when we receive your check results back from the Police
we may need to ask more questions or get clarification from you. You should note that the conviction form from the Police will be
given under the Clean Slate Legislation. You do need to be aware that some convictions do not get cleared by Section 7 of the
Criminal Records (Clean Slate) Act 2004.
Consent for disclosure for a Police Vet check
By signing the declaration you acknowledge and understand as follows:
1. The information about me that NZ Police may consider relevant to my application and release in vetting comprises any
conviction history and, for certain agencies, infringement/demerit reports; and it may include any other information such as
active charges and warrants to arrest, any information received or obtained by NZ Police, and any interaction I have had with
NZ Police in any context (including family violence), even where I have not been charged, or charges are withdrawn, or I have
been acquitted (not guilty) of a charge, or I have been discharged without conviction.
2. Any conviction history will be released in accordance with the Criminal Records (Clean Slate) Act 2004; this means that, if I am
“eligible” for clean slate (e.g., no convictions for seven years, never been to prison, no convictions for specified sexual
offending, etc – see section 7 of the Act):
a) my criminal record of convictions will not be disclosed; but
b) if the role for which I have applied is an exception to the clean slate scheme (e.g., predominantly involving care and
protection of a child or young person), my criminal record of convictions will be disclosed.
3. Where a Court suppression order exists in respect of criminal conviction information not subject to the Clean Slate regime, any
active criminal charge, or any past non-convicted charge, NZ Police may, if it considers the information to be sufficiently
relevant and of concern, disclose in the result:
a) to certain approved agencies, such as government agencies, details of the suppressed information, with a warning
against publication;
b) to other approved agencies, the existence of the suppressed information, without offence details.
4. Where NZ Police holds relevant information that it is unwilling to disclose to the approved agency for privacy, confidentiality or
law enforcement reasons, NZ Police may recommend against unsupervised access to children or vulnerable persons (this is
known as a “red stamp”).
5. The personal information I provide in this form is being collected for vetting purposes and may also be used for the purpose of
updating NZ Police records.
6. I may withdraw this consent, prior to Police’s disclosure of the vetting result, by notifying the approved agency who will
immediately notify NZ Police to cease the vetting process.
7. I am entitled to access the vetting result released to the approved agency and seek correction of Police information about me in
accordance with the Privacy Act 1993 by making a request to the approved agency in the first instance.
8. No later than twelve months after the release of the vetting result, the approved agency will securely dispose of this consent
form and copies of identification documents, as well as the vetting result released by NZ Police, in accordance with the Privacy
Act 1993 or any other enactment, unless a longer retention period is required under legislation.
9. The information I have provided in this form relates to me and is correct.
For further information, see http://www.police.govt.nz/advice/businesses-and-organisations/vetting
14 Signature
In signing this statement, you authorise NZ Police to give the Education Council any information about you that is relevant to us in
determining whether you are “of good character and fit to be a teacher”. This includes any convictions or other relevant information
the Police may hold about you. Make sure you sign and date the form before sending it to the Education Council. We cannot assess
the application without this, to signify your authority and request us to proceed.
Please ensure that the declaration form has the following sections completed correctly:
(1) G10 Each checkbox has been ticked.
(2) G12 Applicant name is printed and can be clearly read.
(3) G13 The declaration has been signed.
(4) G13 Declaration must be dated within the last three months from the day the form is received by the Education Council.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 8 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]
Completing Section I: Professional leader endorsement
15 and 16 Endorsement and endorser details
As a professional leader, you must select either 15a or 15b as the reason for supporting the applicant with this LAT application and ensure
that the appropriate evidence is provided to the Council.
Read the completed application form and all supporting information carefully. If you are unable to attest to any of the statements, do not
complete the testimonial section.
 The applicant must provide independent, objective evidence of a skill shortage in a particular geographic area. As a
professional leader in this geographic area, you are asked to provide professional endorsement of this and that the
applicant has the skills and competencies required to temporarily address the identified shortage.
 When you are endorsing this person you are endorsing the applicant to teach in the identified skills area across a range of
settings. A professional leader employing a person with a Limited Authority to Teach has a responsibility to comply with the
requirements set out in the Limited Authority to Teach Policy. The professional leader must ensure that the person with the
LAT practises only within the scope, location and time for which the LAT was approved.
 The self-reflection should accurately describe the relevance of the applicant’s qualifications and/or recent experience to
learners within the general education system.
 Please provide your details, so that the Education Council can confirm you are the correct person to complete the
endorsement. Sign and date the form. Please note: as the professional leader endorsing this application your name and
registration number will appear as the endorser of this person on the LAT list on the Council’s website.
 For more information, see the Education Council’s Limited Authority to Teach Policy or contact the Education Council for
advice.

Education Council’s commitment to your privacy

The Education Council is committed to observing all the obligations and responsibilities of the Privacy Act 1993, in relation to the
information you provide to us. We offer you the following assurances to support this commitment:
 you are asked to provide the information on this form solely so that the Education Council can consider your eligibility to be
granted a Limited Authority to Teach. We consider this in terms of Section 366 of the Education Act 1989.
 the Education Council will hold the information securely, and will not disclose it to any person or organisation without your
authority, unless required or authorised to do so by law. Note that, in signing Section G, you give your consent for us to
make contact with the listed organisations and people, so that we can process this application.
 you can request under the Privacy Act to see any information that the Education Council holds about you at any time, and
you have the right to ask the Education Council to correct the information. Note that this only applies if you:
 are a New Zealand citizen
 have permanent residency in New Zealand, or
 are in New Zealand when you make the request.
 The Education Council may use the information you provide for statistical purposes. If we do so, it will be published in such
a way that you cannot be identified.
Note: The Education Council makes a LAT list available to the public on its website. This list details the scope of practice currently
authorised to a LAT holder to allow this person to be employed in a teaching position.

What happens next?

 Return the completed application form and any supporting information by post to;
Education Council
P.O. Box 5326
Wellington 6140
New Zealand
or by courier to Level 7, 80 Boulcott Street, Wellington 6011. Our contact phone number is +64 4 471 0852
 The Education Council processes your application fee.
 The Education Council confirms you have provided everything on the form that we need. If we do not have enough information
to make a decision on your application, we will contact you to ask for those details.
 NZ Police uses the details you have provided to run a “vetting” check and replies with the details to the Education Council.
 The Education Council decides whether you meet the criteria to be granted a LAT.
 The Education Council sends you notice of the decision (including your authority letter, if the LAT is granted). A confirmation
email will be sent to your professional leader who completed Questions 15 to 16.
 Applications usually take six weeks to process. A person cannot be employed in a teaching position for more than 10 full days
(or 20 half-days) without holding authorisation for that position. When the application is approved you will receive an email and
a letter.

Form EC40, Version (2018-08-01) Physical Address: Postal Address:

Level 7, 80 Boulcott Street PO Box 5326
Page of 9 of 9 Wellington 6011 Wellington 6140
Telephone: (04) 471 0852 [email protected]