Australian Industrial Relations Commission

Application for relief in relation to termination of employment

Commission use only

File number:

Workplace Relations Act 1996 (Commonwealth)

Subsection 170CE (1)

Date received:

In making this claim you (the applicant) should be aware that:

 specified categories of employees are not able to make or are excluded from making a claim under the Termination of Employment provisions of the Workplace Relations Act 1996.

 an application must be lodged within 21 days after the day on which the termination took effect, or within such period as the Commission allows (see ss 170CE (7)).

 section 170CJ of the Workplace Relations Act 1996 allows the Commission to make an order for costs in certain circumstances.

 regulation 30BD of the Workplace Relations Regulations 1996 requires a fee of $50 to be paid on lodgment of this application with the Commission unless a Registrar is satisfied that the applicant will suffer serious hardship if he or she pays the fee. The $50 lodgment fee is refundable under certain circumstances (see subregulation 30BD (3)).

Details in relation to these matters are available from the Industrial Registry.

Details of Employee (the applicant)

Mr Mrs  Miss  Ms

1 Full name

Family name:

Given names:

2 Home address

 Postcode:

3 Phone or fax number(s)

business hours (     )

after hours (     )

facsimile (     )

4 Date of birth

day/month/year / /

5 First language

English      other     (specify)

Is an interpreter needed?  Yes     No  

Is there a family member or friend who can assist you?  Yes     No  

Details of Employer

6 Employer’s name

 Contact person’s name

7 Employer’s trading address or registered office

 Postcode:

Phone  (     ) Fax  (     )

8 Work performed for employer (occupation)

9 Place of work

Suburb/town: Postcode:

10 Date when you first worked for employer

 / /

11 Date when you last worked for employer

 / /

12 Date termination of employment took effect

 / /

State the date when you think the termination of employment took effect if the date is different from the date when you last worked.

 Did you receive written notice of termination/ separation certificate?

 No      Yes     I attach a copy  

13 Qualifying period of employment

If you commenced employment on or after 30 August 2001, have you and your employer determined by written agreement the qualifying period of employment? (See section 170CE (5A) of the Workplace Relations Act 1996.)

 No     Yes If yes, the qualifying period of employment determined by written agreement:

 (a) began on (date):     /      /      .

 (b) ends/ended on (date):    /      /      .

14 Other employment details (if known)

What is the name of the award or agreement (including Australian Workplace Agreement) under which you were employed immediately before the termination?

Is the award or agreement a State or Federal award?

  Federal      State If State, name of State:

Extension of Time

15 This section must be completed if the application is lodged more than 21 days after the day on which the termination took effect (see item 12). In such cases, the Commission must decide whether to accept the application.

 My reason/s for seeking an extension of time to lodge this application is/are:
write here or attach document

Details of your representative or union

16 Is anyone representing you?

No   go to item 20  /  Yes   go to item 17

17 Name of legal firm, union or other representative

18 Name of contact person at legal firm, union or other representative

19 Contact details of legal firm, union or other representative

 Postcode:

Phone  (     ) Fax  (     )

Notices from the Commission

20 Where do you want notices from the Commission to be sent?

Home address  

Address of solicitor, union or other representative  

Other address  give details

Choose only one option

Grounds for application

21 Grounds upon which this application is based

Identify the ground or grounds under subsection 170CE (1) of the Workplace Relations Act 1996 upon which this application is based:

 (a) on the ground that the termination was harsh, unjust or unreasonable; and/or

 (b) on the ground of an alleged contravention of:

 section 170CK (discrimination or other prohibited reasons); and/or

 section 170CL (failure to notify the CES of redundancies); and/or

 section 170CM (failure to give notice of termination); and/or

 section 170CN (failure to comply with a section 170FA order)

Relief sought

22 What are you seeking?

 reinstatement

 an amount in relation to the remuneration lost, or likely to have been lost, by you, because of the termination

 other - give details

23 Brief summary of reasons given by employer for the termination

Write here or attach document

Declaration

I declare that no proceedings in respect of the termination that is the subject of this claim have been commenced (other than proceedings that have since been discontinued or have failed for want of jurisdiction) by me or on my behalf under any other provision of the Workplace Relations Act 1996 or under any other law of the Commonwealth or of a State or Territory.

I further declare that all the facts in this application are correct and complete to the best of my knowledge and belief.

The employee must sign this declaration unless the application was prepared by a solicitor, union or other representative of the employee.

[signature of employee]

Date              /        /

[signature of solicitor, union or other representative]

Date               /       /

Fee Regulation 30BD of the Workplace Relations Regulations 1996 requires a fee of $50.00 to be paid on lodgment of this application with the Commission unless a Registrar has, in effect, approved the waiving of the fee (in which case a copy of the Registrar’s approval should accompany this application). If an application is lodged by facsimile transmission, credit card details must be provided for payment of the fee (if any).

 cash

 cheque/money order  (to be made payable to Collector of Public Monies, Australian Industrial Registry)

 Bankcard         Visa         Mastercard

 Card Number    __ __ __ __   __ __ __ __   __ __ __ __   __ __ __ __

 Card Expiry Date    __ __ / __ __

 Cardholder’s Name  ……………………………………………….......

 Signature  ………………………………………………

 Any refund of the lodgement fee (see subregulation 30BD (3)) should be forwarded to the applicant at the following address:

Suburb/town: Postcode:

Commission use only

Receipt Number: ........................................ / Credit Transaction

Processed: ..................................................

Australian Industrial Relations Commission

Notice of Employer’s appearance — termination of employment

Workplace Relations Act 1996 (Commonwealth)

Section 170CE

Commission use only

File number:

Date received:

Please place a tick or cross, where necessary, in the boxes below.

Application details (as stated in Form R18)

Mr  Mrs  Ms 
Miss 

1 Full name

Family name:

Given names:

2 Commission Case/
File Number

U

Details of employer

3 Employer named on application

4 Has the applicant given the employer's correct name?

Yes       No  
If no, correct name is

5 Employer’s address

Postcode:

6 Details of contact person

[first name]   [family name]

Phone (      )

Fax (      )

Mobile

7 Employer’s details

  Company

ACN _______________

  Partnership

  Sole trader

  Government Authority

  Other (specify)

8 Was the employer named in item 3 or 4 above the employer of the applicant at the time of termination?

  Yes       No

If no, what was the name and address of employer at time of termination?

9 Was the applicant employed under an award or agreement (including an Australian Workplace Agreement) immediately before the termination?

  Yes       No

If yes, was it: Federal     or State  

If State, which State?

Details of employer’s representative

10 Is anyone representing the employer?

Yes     go to item 11

No      go to item 14

11 Name of solicitor, legal firm, employer organisation or other representative

12 Contact details of solicitor, legal firm, employer organisation or other representative

[first name]    [family name]

Phone (      )

Fax  (       )

Mobile

13 Address of solicitor, legal firm, employer organisation or other representative

Postcode:

Address for notices

14 Where does the employer want notices to be sent?

Business address  

or address of solicitor, employer organisation or other representative 

Choose only one option

Reasons for termination

15 Brief summary of reason(s) given to employee for termination

Write here or attach document

Late lodgment objection (if applicable)

16 If the application was lodged in the Commission more than 21 days after the day on which the termination took effect, the Commission must decide whether to accept the application.

 If the application was lodged out of time, please indicate whether the employer objects to the Commission extending the time for lodgment.

 I object to the Commission extending the time for lodgment and also object to conciliation before determination of the application to extend time; OR

 I object to the Commission extending the time for lodgment but do not object to conciliation before determination of the application to extend time; OR

 I do not object to the Commission extending the time for lodgment.

Dismissal for want of jurisdiction (if applicable)

Note   If the employer intends to move for the dismissal of the application for want of jurisdiction, Form R21A must be completed and filed.

Examples

Examples of jurisdictional grounds on which an employer may move for the dismissal of the application (see sections 170CC and 170CE (5A) Workplace Relations Act 1996 and regulations 30B and 30BB Workplace Relations Regulations 1996) are as follows:

• In the case of an employee who had commenced employment on or after 30 August 2001, the applicant had not completed the qualifying period of employment (see ss 170CE (5A)).

• The applicant was engaged under a contract of employment for a specified period of time (see paragraph 30B (1) (a)).

• The applicant was engaged under a contract of employment for a specified task (see paragraph 30B (1) (b)).

• The applicant was serving a period of probation or a qualifying period of employment, the duration or maximum duration of which was determined in advance and was 3 months or less, or otherwise reasonable given the nature and circumstances of the employment (see paragraph 30B (1) (c)).

• The applicant was a casual employee engaged by a particular employer for a short period.

A casual employee is engaged by a particular employer for a short period if the occasions on which the employee works for that employer under that engagement occur within a period of less than 12 months  (see subregulation 30B (3)).

• The applicant was a trainee employed under a traineeship agreement or an approved traineeship for a specified period, or for the duration of the agreement (see paragraph 30B (1) (e)).

• The applicant was not employed under award conditions and the applicant’s annual remuneration immediately before termination exceeded a specified rate ($75 200, July 2001) (see paragraph 30B (1) (f)).

• The applicant is not covered by a federal award or agreement.

(This may be a relevant objection only in NSW, Qld, WA, SA, Tas. This basis of objection is only applicable if the application is based on the ground that the termination was harsh, unjust or unreasonable.)

• The employer is not a constitutional corporation.

 (This may be a relevant objection only in NSW, Qld, WA, SA, Tas. This ground of objection is applicable only if the application is based on the ground that the termination was harsh, unjust or unreasonable.)

Declaration

I declare that all the facts in this notice are correct and complete to the best of my knowledge and belief.

The employer must sign this declaration unless the application was prepared by a solicitor, employer organisation  or other representative of the employer.

[signature of employer]

Date              /        /

[signature of solicitor, employer organisation or other representative]

Date               /       /

Australian Industrial Relations Commission

Motion to dismiss the application for want of jurisdiction

Workplace Relations Act 1996 (Cwlth)

Section 170CEA

Commission use only

File number:

Date received:

Dismissal for want of jurisdiction

Please place a tick or cross, where necessary, in the boxes below



The respondent moves for the dismissal of the application for want of jurisdiction before the matter is referred for conciliation; OR



The respondent moves for the dismissal of the application for want of jurisdiction but indicates that the motion may be dealt with after the matter is referred for conciliation; OR



The respondent moves (not having previously so moved) for the dismissal of the application for want of jurisdiction as conciliation has not resulted in settlement of this matter; OR



The respondent moves (having previously so moved) for the dismissal of the application for want of jurisdiction.

The respondent moves for the dismissal of the application on the following grounds:

Note   See Form R21 for some examples of jurisdictional grounds on which an employer may move for the dismissal of the application.

Documentation that will be relied on to substantiate the jurisdictional objection must accompany this Notice.

Declaration

I declare that all the facts in this notice are correct and complete to the best of my knowledge and belief.

The respondent must sign this notice unless a solicitor, legal firm, employer organisation or other representative has prepared the notice.

[signature of respondent]

Date              /        /

[signature of solicitor, legal firm, employer organisation or other representative]

Date               /       /