Contract cleaning worker application

Required fields are marked with an asterisk (*).

Personal details

First name *

Middle name

Family name *

Mailing address *

Suburb *

State

-- Please Select --QLDACTNSWNTVICSATASWA

Postcode *

Mobile *

Home phone

Email address *

Date of birth *

Employer details

Employer/business name *

What date did you start work with this employer? *

Employer phone *

Employer ABN *

Employer address *

Suburb *

State

QLDACTNSWNTVICSATASWA

Postcode *

Work type * Select your work type from the options below

-- Please Select --CleanerCleaner/Supervisor (at least 50% of your time must be spent performing cleaning work)Supervisor only

Are you currently working for more than one employer?

If you currently have more than two employers, please contact us to complete a hard copy form.

• Yes
• No

Employer/business name *

What date did you start work with this employer? *

Employer phone number *

ABN *

Address

Suburb

State

QLDACTNSWNTVICSATASWA

Postcode

Work type Select your work type from the options below

-- Please Select --CleanerCleaner/Supervisor (at least 50% of your time must be spent performing cleaning work)Supervisor only

Declaration

I declare that the information provided is true and correct. I understand that for the purposes of the administration of the Act my employer may provide the Authority with updated information relevant to my membership.

• Yes

Name *

Date *