Contract cleaning employer application form

Required fields are marked with an asterisk (*).

Employer details

Legal entity name *

ABN *

Other trading names/business names

ACN

Mailing address *

Suburb *

State

QLDACTNSWNTVICSATASWA

Postcode *

Is your principal place of business different to your mailing address?

• Yes
• No

Postal address

Suburb

State

QLDACTNSWNTVICSATASWA

Postcode

Cleaning type *

• Premises
• Other

Please specify the primary cleaning type your business provides

Legal entity phone *

Mobile

Email *

Contact details

Name of person authorised to speak on behalf of the employer *

Authorised person phone number *

Name of person for general enquiries If different to authorised person

General enquiries phone number If different to authorised person

Email

Address where employment books and records can be inspected In accordance with Section 66 of the Contract Cleaning Industry (Portable Long Service Leave) Act 2005

Suburb

State

QLDACTNSWNTVICSATASWA

Postcode

Worker information

How many workers do you engage? *

Date your business first engaged eligible worker/s *

Declaration

I certify that the information provided is true and correct, and I am authorised to make this declaration for and on behalf of the employer/legal entity

• Yes
• No

Name *

Position *

Date *