Required fields are marked with an asterisk (*).
Employer details
Is your principal place of business different to your mailing address?
Cleaning type *
Contact details
If different to authorised person
If different to authorised person
In accordance with Section 66 of the Contract Cleaning Industry (Portable Long Service Leave) Act 2005
Worker information
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