We strongly advise you to keep a copy of your personal information centre details on the hard drive of your computer.Family name * Given names * Have you been known by any other names? * (including name at birth, previous married names, aliases) Sex * Date of birth *
Place of birth Town/city * Country *
Relationship status Married * Engaged * De facto * Separated * Divorced * Widowed * Never married or been in a de facto relationship *
Preferred Location Within Australia Ideal Position Specialist Skills
Do you hold any citizenship other than that shown as your country of passport above? *
National identity card Details of identity card or identity number issued to you by your government (if applicable) eg. Note: If you are the holder of multiple identity numbers because you are a citizen of more than one country, you need to enter the identity number on the card from the country that you live in.Country of issue * Identity number *
Usual occupation * What type of employment do you intend to seek during your stay? * Qualifications *
Current residential address *
Address for correspondence *
Your telephone numbers Mobile/cell * Office hours * (COUNTRY CODE) (AREA CODE) NUMBER After hours * (COUNTRY CODE) (AREA CODE) NUMBER
If you live outside Australia, please give approximate date of travel/move to Australia Do you have sufficient funds for the initial period of your stay in Australia? * Do you have a return or onward ticket or the funds for a fare to depart Australia? * Do you have any dependent children that will accompany you to Australia? * How many children are travelling *
Do you have a partner that will accompany you to Australia? * Have you previously been to Australia, applied for a visa, held or currently hold a visa for travel to Australia Give full details including type of visa(s), place(s) of application and date(s) of entry to Australia (if applicable)
Have you previously had an Australian visa cancelled, been detained in Australia, removed or deported from Australia
If you are applying for a second Working Holiday visa, have you undertaken 3 months of specified work in regional Australia on a Working Holiday visa? *
In the last 5 years, have you visited, or lived, outside your country of passport for more than 3 consecutive months? Country(s) Date from Date to Country(s) Date from Date to Country(s) Date from Date to
Do you intend to enter a hospital or a health care facility (including nursing homes) while in Australia?
Do you intend to work as, or study to be, a doctor, dentist, nurse or paramedic during your stay in Australia?
Do you intend to work, or be a trainee, at a child care centre (including preschools and creches) while in Australia?
Do you intend to be in a classroom situation for more than 3 months (eg. as either a student, teacher, lecturer, or observer)?
Have you suffered from Tuberculosis? Have you:
Medical follow up during your proposed visit to Australia During your proposed visit to Australia, do you expect to incur medical costs, or require treatment or medical follow up for:
Do you require assistance with mobility or care due to a medical condition?
Do you hold health insurance to cover your stay in Australia? Note: See page 2 of this form for further information about health insurance.
Criminal conviction questions Have you ever been convicted of a crime or offence ? * Have you ever been charged with any offence that is currently awaiting legal action? * Have you ever been acquitted of any criminal offence or other offence * Have you ever been removed or deported from any country ? * Have you ever left any country to avoid being removed or deported? * Have you ever been refused a visa for Australia or another country? * Have you ever been excluded from or asked to leave any country? * Have you ever committed, or been involved in the commission of war crimes or crimes against humanity or human rights abuses * Have you ever been involved in any activities that would represent a risk to Australian national security? * Have you ever had any outstanding debts to the Australian Government or any public authority in Australia ? * Have you ever been involved in any activity, or been convicted of any offence, relating to the illegal movement of people ? * Have you ever served in a military force or state sponsored/private militia, undergone any military/paramilitary training ? * If you answered ‘Yes’ to any of the above questions you must give all relevant details in the space provided below If the matter relates to a criminal conviction, please give the nature of the offence, full details of sentence, dates of any period of imprisonment or other detention and a personal account of the events leading up to and including the offence(s).
Documentation Personal Image * (preferably at work, max: 1 MB) Copy of CV * (max: 1 MB) Copy of Passport * (max: 1 MB) Copy of Trade and/or Professional Certificates * (max: 1 MB) Copy of Relevant Educational Certificates * (max: 1 MB) Copy of Testimonials * (known within the last 5 years. max: 1 MB)
Declaration and consent WARNING: Giving false or misleading information is a serious offence. I declare that:Date *
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