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
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