Civilian Service Medal 1939-1945

Civilian Service Medal 1939-1945

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• 
  a guide to eligibility for the Medal and a list of the approved organisations; and
  
• 
  an application guide to help you fill out the form.
  

• 
  only one Medal can be awarded to recognise eligible service; and
  

• 
  as the Medal will belong to the Estate of that deceased person, the Honours Section will require a Statutory Declaration giving the relationship of the applicant to the deceased person.
  

• 
  A Statutory Declaration is also required by the Honours Section if you are applying for an award on behalf of another person who is unable to apply personally due to illness or infirmity.
  

Honours, Symbols and Territories Branch

 (02) 6271 5627

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  The electorate office staff of your local Federal Member of Parliament or a Senator can also assist with any inquiries about the Civilian Service Medal.
  

Application Form

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  Please read both the Eligibility Guide and the Application Guide before completing this form; and
  
• 
  Please use BLOCK LETTERS.
  

Suburb State Post Code

urrent

home

address


C
Street

Suburb State Post Code
urrent

postal

address

T
( )

( )
elephone

2. Personal details of proposed awardee (person to whom the Medal is to be awarded)

Suburb State Post Code
ddress

at time of

service

during

WWII

• 
  I

  s this person deceased? Yes No

  
  

• 
  What is your relationship to this person?
  

Town State/territory

4. 
   S
   

   ervice details

   
   

• 
  Only the Awardee’s first two given names and surname at the time of service are engraved on the Civilian Service Medal.
  

MP’s name

Senator’s name

7. Declaration

Information provided in this application will be disclosed to other government agencies to validate your service and process your nomination. If approved, your name, clasp name and date of award will appear on www.itsanhonour.gov.au and be accessible to internet users. Your address will only be published if you agree. Once information appears on the internet, the Department of the Prime Minister and Cabinet has no control over its subsequent use and disclosure. Use and disclosure of your personal information is in accordance with the attached Information Privacy Principles 1, 2, 3, 10 and 11 under the (Commonwealth) Privacy Act 1988.

I declare that: a. The details I have given on this form are complete and correct;

b. I have read and understand the attached Information Privacy Principles 1, 2, 3, 10 and 11; and

c. I agree to the proposed awardee’s address appearing on www.itsanhonour.gov.au. YES  or NO  (tick one)

………………………………………………… ………………………………………………….

Please read carefully before you complete the Application Form

1. 
   Personal details of person who is completing the application
   

• 
  give your personal details when applying for an award of a Civilian Service Medal to recognise your service, or
  
• 
  give your personal details in this section if you are making an application for a Civilian Service Medal on behalf of another person who is deceased or a person unable to complete the form through illness or infirmity.
  

• 
  give the Australian State/Territory where the proposed awardee first enrolled in the organisation/s for which service is being claimed;
  
• 
  give the location where this wartime service occurred;
  
• 
  give the date of enrolment and the date of discharge for service in the organisation/s; and
  
• 
  send copies only with the application form of any personal documentation to assist in verifying service, such as
  

• 
  only two given names and the surname at the time of wartime service are engraved on the Civilian Service Medal
  

• 
  titles and post-nominals cannot be engraved
  

3. 
   The medal can be presented to you personally by a Senator for your State/Territory.
   

• 
  the declaration stating that the details provided in the application are complete and correct; and
  
• 
  the authorisation to allow the disclosure of the information contained in your application to other Commonwealth agencies involved in the administrative procedures for the Medal.
  

• 
  all relevant sections of the application have been filled out;
  
• 
  relevant authorisations and declarations have been completed and signed;
  
• 
  relevant documentation has been enclosed; and
  
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  for future reference record the date of your application …/…/…
  

Honours Section 2013

1. Personal information shall not be collected by a collector for inclusion in a record or in a generally available publication unless:

(a) the information is collected for a purpose that is a lawful purpose directly related to a function or activity of the collector; and

(b) the collection of the information is necessary for or directly related to that purpose.

2. Personal information shall not be collected by a collector by unlawful or unfair means.

IPP 2 - Solicitation of personal information from individual concerned

Where:

(b) the information is solicited by the collector from the individual concerned;

the collector shall take such steps (if any) as are, in the circumstances, reasonable to ensure that, before the information is collected or, if that is not practicable, as soon as practicable after the information is collected, the individual concerned is generally aware of:

(c) the purpose for which the information is being collected;

(d) if the collection of the information is authorised or required by or under law - the fact that the collection of the information is so authorised or required; and

(e) any person to whom, or any body or agency to which, it is the collector's usual practice to disclose personal information of the kind so collected, and (if known by the collector) any person to whom, or any body or agency to which, it is the usual practice of that first mentioned person, body or agency to pass on that information.

IPP 3 - Solicitation of personal information generally

The information must be relevant, up to date and complete. The collection of the information must not be unreasonably intrusive.

Where:

(b) the information is solicited by the collector:

the collector shall take such steps (if any) as are, in the circumstances, reasonable to ensure that, having regard to the purpose for which the information is collected:

(c) the information collected is relevant to that purpose and is up to date and complete; and

(d) the collection of the information does not intrude to an unreasonable extent upon the personal affairs of the individual concerned.
continued overleaf 

Civilian Service Medal

Application Guide (cont’d)
IPP 10 - Limits on use of personal information

Outlines the rules about keeping accurate, complete and up to date personal information; using information for a relevant purpose; and only using the information for another purpose with your consent unless special circumstances apply such as health and safety or law enforcement.

1. A record-keeper who has possession or control of a record that contains personal information that was obtained for a particular purpose shall not use the information for any other purpose unless:

(a) the individual concerned has consented to use of the information for that other purpose;

(b) the record-keeper believes on reasonable grounds that use of the information for that other purpose is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or another person;

(c) use of the information for that other purpose is required or authorised by or under law;

(d) use of the information for that other purpose is reasonably necessary for enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue; or

(e) the purpose for which the information is used is directly related to the purpose for which the information was obtained.

2. Where personal information is used for enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue, the record-keeper shall include in the record containing that information a note of that use.

IPP 11 - Limits on disclosure of personal information

Sets out when an agency can disclose personal information about you to someone else, for example another agency.

1. A record-keeper who has possession or control of a record that contains personal information shall not disclose the information to a person, body or agency (other than the individual concerned) unless:

(a) the individual concerned is reasonably likely to have been aware, or made aware under Principle 2, that information of that kind is usually passed to that person, body or agency;

(b) the individual concerned has consented to the disclosure;

(c) the record-keeper believes on reasonable grounds that the disclosure is necessary to prevent or lessen a serious and imminent threat to the life or health of the individual concerned or of another person;

(d) the disclosure is required or authorised by or under law; or

(e) the disclosure is reasonably necessary for the enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the protection of the public revenue.

2. Where personal information is disclosed for the purposes of enforcement of the criminal law or of a law imposing a pecuniary penalty, or for the purpose of the protection of the public revenue, the record-keeper shall include in the record containing that information a note of the disclosure.