AmrickCivilSignUp

PLEASE ENSURE YOU HAVE ALL PAY RECORD INFORMATION BEFORE PROCEEDING

Please confirm and click next(Required)

YES... I have my: BANK, TAX, SUPER, PROTECT, COINVEST details and at least one EMERGENCY CONTACT

GENERAL DETAILS

Name(Required)

Prefix First Last

Phone(Required)

Email(Required)

Date of birth(Required)

DD slash MM slash YYYY

Address (home address in Australia)(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Shirt/top size (for PPE)(Required)

TAX FILE NUMBER DETAILS

Tax file number(Required)

Previous name registered with ATO (if applicable)

If you have changed your name since you last dealt with the ATO, please provide your previous family name

Basis of payment(Required)

Casual employment

Full-time employment

Part-time employment

Labour hire

Superannuation or annuity income stream

On what basis are you paid? (select one only)

Residency/visa status(Required)

An Australian resident for tax purposes

A foreign resident for tax purposes

A working holiday maker

What is your current residency or visa stuff in Australia? (Select only one)

Do you want to claim the tax-free threshold from this payer?(Required)

YES

NO (Answer no here if you are a foreign resident or working holiday maker, except if you are a foreign resident in receipt of an Australian Government pension or allowance.)

Only claim the tax-free threshold from one payer at a time, unless your total income from all sources for the financial year will be less than the tax-free threshold.

Do you have a Higher Education Loan Program (HELP), Student Start-up Loan (SSL) or Trade Support Loan (TSL) debt?(Required)

YES (Your payer will withhold additional amounts to cover any compulsory repayment that may be raised on your notice of assessment.)

Do you have a Financial Supplement debt?(Required)

YES (Your payer will withhold additional amounts to cover any compulsory repayment that may be raised on your notice of assessment.)

ACCOUNT DETAILS

Bank account name(Required)

BSB number(Required)

Account number(Required)

Name of bank(Required)

MEMBERSHIPS/TICKETS

Super fund name(Required)

Super fund member number(Required)

CoInvest fund member number(Required)

Protect fund member number(Required)

AWU member number

RIW card number

White card state issued(Required)

Tickets/Qualifications

Scissor / EWP

Rigger/dogman

Forklift

OH&S

Spotter

Scaffolder

First aid

Traffic control

Plant / machine operator

Steelfixer (panel specific)

MEDICAL/EMERGENCY

Emergency contact 1 - Name(Required)

Emergency contact 1 - Phone(Required)

Relationship to emergency contact 1(Required)

Emergency contact 2 - Name

Emergency contact 2 - Phone

Relationship to emergency contact 2

Medical conditions / pre-existing injuries

Please detail any information relating to current or previous medical conditions and/or injuries if applicable.

DECLARATION BY PAYEE

I declare that the information I have given is true and correct (sign here)(Required)

Date(Required)

DD slash MM slash YYYY