General Registration

Step 1 of 6

Your Name*

Email*

Phone*

Date of Birth*

Your Address*

Are you an Australian citizen?*

Yes

Country of Citizenship*

Passport or Document Number*

Passport or Document Expiry Date*

Are you of Aboriginal and/or Torres Strait Islander origin?*

Yes - Aboriginal

Yes - Torres Strait Islander

Yes - both Aboriginal and Torres Strait Islander

COVID-19 Vaccination Status*

The Australian Federal and State Governments have introduced requirements that employees working in particular industries and job positions be vaccinated with one or both doses of the COVID-19 vaccine. Some of our clients operate in these high risk and vulnerable industries and working environments and in order to protect the community require the vaccination status of employees to ensure they are complying with the Governments requirements. Should you give your consent, your vaccination status will only be disclosed to a client if and when they enquire and will otherwise remain confidential.

Yes - I give my consent

No - I do not give my consent

What is your COVID-19 vaccination status?*

Vaccinated - 2 doses received

Partially vaccinated - 1 dose received

Not vaccinated - awaiting scheduled appointment

Not vaccinated - medical exemption

Not vaccinated - not intending to vaccinate

Prefer not to disclose

Vaccination 1 Date*

Vaccination 1 Type*

(Example: AstraZeneca, Pfizer, Moderna or Other)

Vaccination 2 Date*

Vaccination 2 Type*

(Example: AstraZeneca, Pfizer, Moderna or Other)

When is your Vaccination 2 Date scheduled?*

When is your Vaccination 1 Date scheduled?*

Medical Exemption

Please upload your Medical Exemption as a Word or PDF.

Accepted file types: doc, docx, pdf, Max. file size: 128 MB.

General Registration

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Brisbane

Gladstone

Newcastle