form styling test Further information about your circumstances Instructions for using this form Please fill in as much information as you can. It's okay if you don't know the answers to all these questions. However, the more information you give us, the easier it is for us to help you. Some questions are marked "required" which means you must try to answer them before you can send this form. If you don't understand the form or are having trouble filling it out, you can call us on (08) 6148 3636 to request a team member call you back to go through the form with you over the phone instead. Privacy statement You should have read our privacy statement when you made your online enquiry. If you did not, you can access it below. It's important that read the privacy statement before providing your details to us. Click here to read the privacy statement. We do not provide advice by email. If you have a disability that prevents you from speaking to us on the phone, please let us know in the form below.I have read and understood the privacy statement and all the information aboveIf you cannot read or don't understand the privacy statement you should call our Advice Line instead. If you are eligible to receive legal advice, a member of staff can explain the privacy statement to you. Click here for information on how to call our Advice Line. Personal detailsFamily name(required)First name(s)(required)Enter your full name. We are unable to provide advice if you do not give your full name. Telephone number(required)Please provide a telephone number we can call you on to provide assistance. It is important that this number is safe for us to contact. Please avoid providing a work number.Second telephone number (if you have a second number)We will only call this number if we can't get through to you on the first number you have provided above. Email address(required)Please provide an email address that is safe for us to contact and that you check regularly. Address Line 1(required)Please provide an address that is safe for us to contact if we cannot contact you by telephone or email. Address Line 2Suburb(required)Postcode(required)What is your date of birth?(required)Gender(required)MaleFemaleNon-binaryOtherPrefer not to discloseIf other, please describe: Do you identify as Aboriginal or Torres Strait Islander?(required)YesNoPrefer not to discloseIs English the main language you speak at home?(required)YesNoWhat is the main language you speak at home?Will you require an interpreter when we call you?YesNoWhat is your residency status? (required)I am an Australian citizenI am an Australian permanent residentI am in Australia on a temporary visaOtherWhat is your nationality?Were you born in Australia? YesNoWhat is your country of birth / origin? What year did you arrive in Australia?Do you have any disabilities?(required)YesNoPrefer not to discloseWhat is your disability?Do you have any problems reading or writing English?(required)YesNoPrefer not to discloseIf yes, please describe:What was your income in the last 12 months before tax (gross)? (required)If you don't know the exact amount you've earned in the last 12 months, please make your best estimate. What is your current income? If your current income is different than your income in the last 12 months, please provide your current income here. What is your main income source?Wages / salary from jobCentrelink benefitsOtherIf other, please describe: What is your relationship status? (required)SingleDe factoMarriedSeparatedDivorcedWidowedPlease choose the option that best describes your current relationship status. Does your partner earn an income that is shared within your household? (required)YesNoWhat was your partner's income in the last 12 months before tax (gross)?(required)If you don't know the exact amount your partner earned in the last 12 months, please make your best estimate. Do you have any dependants?(required)YesNoA dependant is a child or another person who relies on your financial support.How many dependant children do you have? (required)How many other dependants do you have? (required) Employer detailsWhat is your employer's ABN?An "ABN" is an Australian Business Number. You can normally find your employer's ABN on your payslips or group certificate. We will still accept your application if you don't know your employer's ABN, however you should make an effort to find it as we may not be able to provide accurate advice without it. If your issue is with a previous employer, enter that employer's ABN, not your current employer. Where is this ABN from? Pay slipEmployment contractTax payment summaryWagelineABN / ASIC searchOtherDid you receive pay slips from the employer?(required)YesNoI don't knowWhat is the trading or business name of your employer?If your issue is to do with a previous employer - enter the name of your previous employer, not your current employer.What type of employer do you work for?Pty Ltd companyOther type of trading companyEducational institutionEmployment agencyCommonwealth Government agencyState Government AgencyPartnershipOtherSole traderTrusteeI don't knowWhich of the following best describes the industry your employer works in?Accommodation / foodAdministrative / supportAgriculture /forestry / fishingArts / recreationConstructionEducation / trainingElectricity / gas / water / wasteHealth care / social assistanceInformation media / telecommunicationsManufacturingMiningProfessional / scientific / technicalPublic administration / safetyRental / hiring / real estateRetail tradeTransport / postal / warehousingWholesale tradeOtherHow many employees does your employer have?Fewer than 1515 or moreI'm unsure Employment detailsWhat is (or was) your salary or hourly rate with your employer?Please selectHourlyDailyWeeklyFortnightlyMonthlyYearlyOtherHow many hours (on average) did you work or do you work per week?What is (or was) your position or job title with your employer?Did you sign a written employment contract or letter of offer with your employer? YesNoUnsureDo you know if your employment is covered by an award or registered agreement (e.g. enterprise agreement)?Yes - awardYes - registered agreementNo - I am not covered by an award or enterprise agreementI don't know If you don't know what an award or registered agreement is, please select I don't know and we may be able to help you with this. What is the name of the award?What is the name of the agreement?Which of the following best describes the type of worker that you are (or were) while working with your employerCasual full time (38+ hours per week)Casual part time (less than 38 hours per week)Permanent full time (38+ hours per week)Permanent part time (less than 38 hours per week)Fixed term contract Contractor or sub-contractorSelf-employedWhat was the date that you first started working with your employer?(required)If you are not sure of the exact date, please provide your best estimate (or a month and year).Are you still employed by the employer you are contacting us about?YesNo, I was dismissedNo, I was made redundantNo, I resigned voluntarilyNo, I was forced to resignI don't knowOtherPlease provide detailsWhen is / was your last day of work?If you are not sure of the exact date, give us your best estimate. When were you dismissed / forced to resign?If you are not sure of the exact date, give us your best estimate. Problem or issue detailsAre there any other people you are in conflict with in relation to your issue at work? For example, boss, colleague, HR person?(required)Enter the full names of any one else directly involved in the issue or issues you are having. Problems/issuesI've been firedI've been forced to quitI've been made redundantI've been discriminated againstI have an issue with my contractI'm being bulliedI'm not being paid properlyI'm not receiving an entitlementI think my workplace is unsafeMy employer is trying to change my jobCheck any boxes that you think apply to any of the problems/issues you are experiencing at work. If none apply, describe your problem or issue in the next section. Brief description of the problem or issue(required)Please briefly outline the problem or issue you are having at work. Your entry is limited to approximately 300 words. We will be able to take more complete instructions from you when we call you. What questions do you have for us?(required)Please write down the questions you want answeredWhat is your ideal outcome? Contact timeIf there is a time, or times that you are not available for an employment law advice call, please tick the boxes below. If you have limited availability, you may have to wait longer for advice. Please note we may be calling from a blocked number with no caller ID. Please make your best efforts to answer your phone over the coming period. If we cannot successfully call you after 3 attempts, you will receive an email requesting that you resubmit your online enquiry. If you cannot, or would prefer not to accept a phone call because of a hearing impairment or other disability, please check the box at the bottom of the list. Unavailable days / timesPlease select all days / times you are NOT available for an employment law advice call:Mondays 9am - 12pm Mondays 1pm - 4pm Tuesdays 9am - 12pm Tuesdays 1pm - 4pm Tuesdays 5pm - 7.30pmWednesdays 9am - 12pmWednesdays 1pm - 4pmThursdays 9am - 12pm Thursdays 1pm - 4pmFridays 9am - 12pmFridays 1pm - 4pmI cannot take phone calls due to a hearing impairment or other disability Referral pathwayHow did you find out about our service?(required)Internet searchWageline Fair Work Ombudsman / InfolineFair Work CommissionWA Industrial Relations CommissionA friend told me OtherPlease provide detailsI declare that everything in this form is true and correct. I understand that I may be asked to provide evidence verifying the information I have provided, and agree to provide such evidence if asked.I agree with the statement aboveProviding false information can make it difficult for us to provide accurate adviceSendThis field should be left blank