Fair Work Australia Rules 2010

Telephone:

Schedule 1 Table of forms contained in Schedule 2

(subrule 6.1)

Description	Form	Rule	Legislation*
No Specific Form
Application (No specific form provided)	F1	6.3
Unfair Dismissal
Application for Unfair Dismissal Remedy	F2		s.394 FW Act
Employer’s Response to Application for Unfair Dismissal Remedy	F3	14A, 15
Objection to Application for Unfair Dismissal Remedy	F4	15
Application for Security for Payment of Costs	F5	16	s.404 FW Act
[Note: Forms for applications for FWA to deal with general protections or unlawful termination disputes appear in the Dispute Resolution section below.]
Costs
Application for Costs	F6		ss.376, 401, 611, 780 FW Act
Appeals
Notice of Appeal	F7	12	s. 604 FW Act
Dispute Resolution
Application for FWA to Deal with a General Protections Dispute	F8		ss.365, 372 FW Act
Employer’s Response to Application for FWA to Deal with a General Protections Dispute	F8A	16A
Application for FWA to Deal with an Unlawful Termination Dispute	F9		s.773 FW Act
Employer’s Response to Application for FWA to Deal with an Unlawful Termination Dispute	F9A	16AA
Application for FWA to Deal with a Dispute in Accordance with a Dispute Settlement Procedure	F10		s.739 FW Act, and transitional provisions re disputes under WR Act instruments
Application for FWA to Deal with a Bargaining Dispute	F11		s.240 FW Act
Application for FWA to Deal with a Right of Entry Dispute	F12		s.505 FW Act
Application for FWA to Deal with a Stand Down Dispute	F13		s.526 FW Act
Unprotected Industrial Action
Application for an Order to Stop etc. (Unprotected) Industrial Action	F14		ss.418, 419 FW Act
Enterprise Agreements
Application for Approval of Enterprise Agreement	F16		s.185 FW Act
Employer’s Declaration in Support of Application for Approval of Enterprise Agreement	F17		s.185 FW Act
Declaration of Employee Organisation in Relation to Application for Approval of Enterprise Agreement	F18		s.185 FW Act
Application for Approval of Greenfields Agreement	F19		s.185 FW Act
Employer’s Declaration in Support of Application for Approval of Greenfields Agreement	F20		s.185 FW Act
Declaration of Employee Organisation in Support of Application for Approval of Greenfields Agreement	F21		s.185 FW Act
Application for Approval of Variation of Enterprise Agreement	F23		s.210 FW Act
Employer’s Declaration in Support of Approval of Variation of Enterprise Agreement	F23A		s.210 FW Act
Declaration of Employee Organisation in Support of Approval of Variation of Enterprise Agreement	F23B		s.210 FW Act
Application for Termination of Enterprise Agreement	F24		ss.222, 225 FW Act
Transitional Instruments
Application to Vary Transitional Instrument to Remove Ambiguities etc.	F25		Sch 3, item 10 Transitional Act
Application for Termination of Collective Agreement-based Transitional Instrument	F28		Sch 3, items 15, 16 Transitional Act
Application for Approval of Termination of Individual Agreement-based Transitional Instrument	F29		Sch 3, items 17, 19 Transitional Act
Bargaining
Application for a Majority Support Determination	F30		s.236 FW Act
Application for a Scope Order	F31		s.238 FW Act
Application for a Bargaining Order	F32		s.229 FW Act
Application for a Serious Breach Declaration	F33		s.234 FW Act
Application for a Protected Action Ballot Order	F34		s.437 FW Act
Application for Variation of a Protected Action Ballot Order	F35		s.447 FW Act
Application for Revocation of a Protected Action Ballot Order	F36		s.448 FW Act
Application for an Order to Suspend or Terminate Protected Industrial Action	F37		ss.423–426 FW Act
Application for an Order for an Extension of a Suspension of Protected Industrial Action	F38		s.428 FW Act
Application for an Order in Relation to Partial Work Bans	F39		s.472 FW Act
Transfer of Business
Application for Orders in Relation to Transfer of Business	F40		ss.318, 319 FW Act
Application to Vary a Transferable Instrument	F41		s.320 FW Act
Right of Entry
Application for an Entry Permit	F42		s.512 FW Act
Application for an Order for Access to Non-member Records	F43		s.483AA FW Act
Application for an Exemption from Requirement to Provide Entry Notice	F44		s.519 FW Act
Application for an Affected Member Certificate	F45		s.520 FW Act
Awards
Application to Vary a Modern Award	F46		ss.157–160 FW Act
Application to Vary a Pre-reform or Transitional Award	F47		Sch 3, item 12 or Sch 20, Transitional Act
Take-home Pay Order
Application for a Take-home Pay Order (Individual Employee/Outworker)	F47A		Sch 5, item 9, Transitional Act
Response to Application for a Take-home Pay Order (Individual Employee/Outworker)	F47B	16B.1
Application for a Take-home Pay Order (Multiple Employees/Outworkers)	F47C		Sch 5, item 9, Transitional Act
Response to Application for a Take-home Pay Order (Multiple Employees/Outworkers)	F47D	16B.2
Procedural
Application for Directions on Procedure	F48	5
Application for Order for Substituted Service	F49	10
Notice of Discontinuance	F50		s.588 FW Act
Order Requiring a Person to Attend Fair Work Australia	F51	18	para 590(2)(a) FW Act
Order Requiring Production of Documents etc. to Fair Work Australia	F52	19	para 590(2)(c) FW Act
Notice of Representative Commencing to Act	F53	17.1	s.596(2) FW Act
Notice of Representative Ceasing to Act	F54	17.3	s.596(2) FW Act
Organisations
Application by an Association of Employers for Registration as an Organisation	F55		para 21(1)(a) FW (RO) Regs
Application by an Association of Employees (Other than an Enterprise Association) for Registration as an Organisation	F56		para 21(1)(a) FW (RO) Regs
Application by an Enterprise Association of Employees for Registration as an Organisation	F57		para 21(1)(a) FW (RO) Regs
Notice of Objection to the Registration of an Association	F58		reg 23 FW (RO) Regs
Application for Leave to Change Name/and to Alter Rules	F59		subreg 27(a) FW (RO) Regs
Application by an Organisation for Cancellation of Registration	F60		para 34(1)(a) FW (RO) Regs
Notice of Objection to the Cancellation of Registration of an Organisation	F61		paras 34(5)(a), 36(4)(a) FW (RO) Regs
Application for Cancellation of Registration of an Organisation	F62		para 35(1)(a) FW (RO) Regs
Ballot Paper Chosen by Organisation in Relation to Proposed Amalgamation	F63		para 60(2)(a) FW (RO) Regs
Ballot Paper in Relation to Proposed Amalgamation	F64		para 60(2)(b) FW (RO) Regs
Ballot Paper Chosen by Organisation and Containing an Alternative Provision in Relation to Proposed Amalgamation	F65		para 60(3)(a) FW (RO) Regs
Ballot Paper Containing an Alternative Provision in Relation to Proposed Amalgamation	F66		para 60(3)(b) FW (RO) Regs
Application for Consent to Change the Name of an Organisation	F67		para 121(1)(a) FW (RO) Regs
Application for Consent to the Alteration of Eligibility Rules of an Organisation	F68		para 121(1)(b) FW (RO) Regs
Application for Consent to the Alteration of Eligibility Rules of an Organisation by General Manager	F68A		para 125B(1)(a) FW (RO) Regs
Application for Certificate under Section 180 of the Fair Work (Registered Organisations) Act 2009	F69		para 128(1)(a) FW (RO) Regs
Application for Renewal of Certificate under Section 180 of the Fair Work (Registered Organisations) Act 2009	F70		para 129(3)(a) FW (RO) Regs
Application for a Representation Order	F71		s.137A FW (RO) Act

* Notes:

FW Act means Fair Work Act 2009;

FW (RO) Act means Fair Work (Registered Organisations) Act 2009;

FW (RO) Regs means Fair Work (Registered Organisations) Regulations 2009;

Transitional Act means Fair Work (Transitional Provisions and Consequential Amendments) Act 2009;

WR Act means Workplace Relations Act 1996.

Schedule 2 Forms

Form F1 Application (No specific form provided)

(Subrule 6.3, Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION (NO SPECIFIC FORM PROVIDED)

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:			Postcode:
If the Applicant is a company or organisation:
Contact person:				ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:			Mobile:
Fax:			Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:		Postcode:
Contact person:
Telephone:			Mobile:
Fax:			Email:

Respondent(s)

Name:
	ABN: [If known]
Address:
Suburb:		State:		Postcode:
Contact person: [If known]
Telephone:			Mobile:
Fax:			Email:

The Applicant applies, pursuant to the provision(s) in part 1, for the order or relief set out in part 2 on the grounds specified in part 5.

1. Provision(s) under which application is made:

[Set out the provision(s) of the Act or other legislation under which the application is made.]

2. Order or relief sought:

[Set out the terms of the order or relief sought.]

3. What is the industry of the employer?

[Specify industry.]

4. Relevant industrial instrument(s) (if any):

[Set out any modern award, agreement or other industrial instrument relevant to the application and their ID/Code number(s) if known.]

5. Grounds:

[Using numbered paragraphs, set out the grounds, including particulars, upon which the Applicant relies in seeking such order or relief.]

Date:
Signature:
Name:
Capacity/Position:
[If not signed by the Applicant.]

Service requirements

This application must be served on the named Respondent(s) as soon as practicable after the application is lodged with FWA.

This application must also be served on other persons as directed by FWA if and when such direction(s) are given.

Note: Rules 9 and 10 deal with service.

Form F2 Application for Unfair Dismissal Remedy

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.: U

APPLICATION FOR UNFAIR DISMISSAL REMEDY

Fair Work Act 2009—s.394

[If you require information about completing and lodging this form, please go to http://www.fwa.gov.au or call 1300 799 675.]

Applicant (Employee)

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:	Postcode:
Email:		Telephone:
Fax:		Mobile:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Email:		Telephone:
Fax:		Mobile:

Respondent (Employer)

Legal name:
Trading name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person:
Email:		Telephone:
Fax:		Mobile:

1. What was the period of your employment?

Date employed:

Date notified of dismissal:

Date dismissal took effect:

2. What were the reasons for dismissal, if any, given by your employer?

[Using numbered paragraphs, briefly specify the reason(s), if any, given by the employer for your dismissal. Attach any letter of dismissal and/or separation certificate given to you by your employer.]

3. Why was the dismissal unfair?

[Using numbered paragraphs, give a description of the relevant facts and circumstances and specify why you say the dismissal was unfair. This should include your response to any reasons for dismissal given by the employer. Attach additional pages if necessary.]

4. For the purposes of participating in a conciliation conference do you think you need an interpreter other than a family member or friend?

[ ] Yes — language: [insert your first language]

[ ] No

Date:
Signature:
Name:
Capacity/Position:
[If not signed by the Applicant.]

Service requirements

This form will be served upon the Respondent by FWA.

Notice to the Respondent

A respondent must, within 7 days of being served with this application, lodge with FWA and serve on the applicant a response to the application in accordance with Form F3. A copy of that form can be downloaded at www.fwa.gov.au.

See next page for application fee details.

Application fee

The legislation requires a fee to be paid on lodgment of this application with Fair Work Australia unless such requirement is waived by the General Manager on grounds of financial hardship. The fee is adjusted automatically from time to time. The current amount of the fee and information on seeking a waiver can be obtained by contacting FWA on 1300 799 675 or at www.fwa.gov.au.

If an application is lodged at a FWA office, the fee can be paid by cash, cheque, money order or credit card (Visa or MasterCard).

If an application is lodged by mail, the fee can be paid by cheque, money order or credit card (in which case, provide credit card details below).

If an application is lodged by fax, the fee must be paid by credit card (provide credit card details below).

If an application is lodged by email or online in accordance with rule 7, credit card details must not be provided on this form. Payment of the fee can only be made via FWA’s eFiling facility at www.fwa.gov.au.

[ ] cash

[ ] cheque/money order (to be made payable to: Collector of Public Monies, FWA)

[ ] Visa

[ ] MasterCard

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Card expiry date: __ __ / __ __

Cardholder’s name: ..............................................................................................

Signature: ...............................................................................................................

Any refund of the application fee will be forwarded to the Applicant at the address on the application form.

FWA use only

FWA Matter No.: U..................................................

Receipt No.: ............................................................. / Credit Transaction

Processed by: ...........................................................

Note: A copy of the completed Form F2 (and any attachments but excluding this page) will be forwarded to your former employer by FWA.

PLEASE RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS

External Research

From time to time Fair Work Australia undertakes research with participants in unfair dismissal matters to ensure a high quality process. As some research may be undertaken by external providers on behalf of FWA, your contact details may be provided to an external provider for the purposes of inviting you to participate in research. Please mark the box below if you object to being contacted for the purposes of FWA research.

I object to being contacted for the purposes of FWA research

Form F3 Employer’s Response to Application for Unfair Dismissal Remedy

(Rules 14A and 15, Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA

FWA Matter No.: U

[Insert FWA matter number appearing on the main application form.]

Applicant (Employee):

[Insert name of employee from main application.]

Respondent (Employer):

[Insert name of employer.]

EMPLOYER’S RESPONSE TO APPLICATION FOR UNFAIR DISMISSAL REMEDY

[If you require information about completing and lodging this form, please go to www.fwa.gov.au or call 1300 799 675.]

Respondent (Employer)

Legal name:
Trading name:
	ABN:
Address:
Suburb:	State:	Postcode:
Contact person:
Email:	Telephone:
Contact number for telephone conciliation (if different from above):
Fax:	Mobile:

Respondent’s representative (if any)

Name:
Address:
Suburb:	State:	Postcode:
Contact person:
Email:	Telephone:
Fax:	Mobile:

1. What was the Applicant’s period of employment?

If you disagree with the period of employment specified in the Application for Unfair Dismissal Remedy, please provide the following information:

Date employed:
Date notified of dismissal:
Date dismissal took effect:

2. What were the reasons for dismissal?

[Using numbered paragraphs, briefly specify the reasons for dismissing the Applicant. Attach any letter of dismissal and/or separation certificate.]

3. What is your response to the Applicant’s contentions?

[Using numbered paragraphs, briefly set out your response to the Applicant’s contentions as to why the dismissal was unfair.]

4. Do you have any jurisdictional or other objection(s) to the application?

[Using numbered paragraphs, set out any jurisdictional or other objection(s) you have to the application and specify briefly the ground(s) and particulars for each objection. See the guide accompanying this form or go to http://www.fwa.gov.au/index.cfm?pagename=dismissalsprocess for more information on the objections available under the Fair Work Act.

Note: It is not necessary to specify as an objection that the dismissal was fair.]

5. How many employees did you have at the earlier of either time: the time when the employee was given notice of the dismissal, or the time immediately before the dismissal?

[Go to http://www.fwa.gov.au/documents/definition_small_business.pdf for information on calculating the number of employees.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This Response (including any supporting documentation accompanying the Response) must be lodged with FWA and served on the Applicant within 7 days of being served with the Form F2 application or in accordance with any instruction given by FWA.

Serving a document means giving a copy of the document to the person being served in a manner provided for in the Fair Work Australia Rules 2010. Rule 9 sets out the ways in which a document can be served. For example, you can serve the Applicant by sending the document by Express Post (retaining the sender’s copy of the identifying barcode), registered post to the address specified for the Applicant in the application or by email to the email address for the Applicant specified in the application.

External Research

I object to being contacted for the purposes of FWA research

Form F4 Objection to Application for Unfair Dismissal Remedy

(Rule 15, Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA

FWA Matter No.: U

[Insert FWA matter number appearing on the main application form.]

Applicant (Employee):

[Insert name of employee from main application.]

Respondent (Employer):

[Insert name of employer.]

OBJECTION TO APPLICATION FOR UNFAIR DISMISSAL REMEDY

[If you require information about completing and lodging this form, please go to www.fwa.gov.au or call 1300 799 675.]

The Respondent objects to the Application for Unfair Dismissal Remedy and seeks the dismissal of the application on the following ground(s):

[Using numbered paragraphs, set out any jurisdictional or other objection(s) you have to the application and specify briefly the ground(s) and particulars for each objection. Go to http://www.fwa.gov.au/index.cfm?pagename=dismissalsprocess for more information on the objections available under the Fair Work Act.

Note: It is not necessary to specify as an objection that the dismissal was fair.]

Date:
Signature:
Name:
Capacity/Position:

Lodged by the Respondent	Telephone:
Address for Service:	Fax:
	Email:

[This information block should appear at the foot of the first page of this form and any witness statements, statutory declarations or submissions. This can be done, e.g., by using cut and paste once the document has been completed.]

Service requirements

This form must be served on the Applicant as soon as practicable after it is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F5 Application for Security for Payment of Costs

(Rule 16, Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA

FWA Matter No.:

[Insert FWA matter number appearing on main application form.]

Applicant (Employee):

[Insert name of Applicant from main application.]

Respondent (Employer):

[Insert name of Respondent from main application.]

APPLICATION FOR SECURITY FOR PAYMENT OF COSTS

Fair Work Act 2009—s.404

1. Party seeking security for costs order:

[Insert name of party seeking security for costs order.]

2. Person against whom security for costs order is sought:

[Insert name of party/person against whom security for costs order is sought.]

3. Grounds:

[Using numbered paragraphs, specify briefly the grounds on which the application for a security of payment of costs order is based. Attach additional pages if necessary.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This form must be served on the party against whom security for payment of costs is sought as soon as practicable after the document is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F6 Application for Costs

IN FAIR WORK AUSTRALIA

FWA Matter No.:

[Insert FWA matter number appearing on main application form.]

Applicant (Employee):

[Insert name of Applicant from main application.]

Respondent (Employer):

[Insert name of Respondent from main application.]

APPLICATION FOR COSTS

Fair Work Act 2009—ss.376, 401, 611, 780

1. Party applying for a costs order:

[Insert name of party applying for costs order.]

2. Party/Person against whom a costs order is sought:

[Insert name of party/person against whom a costs order is sought.]

3. Grounds:

[Using numbered paragraphs, specify briefly the grounds on which the application for a costs order is based. Attach additional pages if necessary.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This form must be served on the Respondent against whom the order is sought as soon as practicable after the form is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F7 Notice of Appeal

(Rule 12, Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

NOTICE OF APPEAL

Fair Work Act 2009—s.604

Appellant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Appellant is a company or organisation:
Contact person:			ABN:
Contact details for the Appellant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Appellant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Decision appealed:

The Appellant, being a person aggrieved, gives notice of an appeal against a decision made in a matter as follows:

Matter number:
[FWA matter number of matter under appeal]
Applicant:
[Name of applicant(s) in matter under appeal]
Respondent(s):
[Name of respondent(s), if any, in matter under appeal]
Decision maker:
[Name of member or delegate of FWA]
Decision appealed:
[Description of decision and order, if any, appealed and include decision citation (e.g. [2009] FWA 365) if known]
Date of decision:
[Date]

2. Grounds:

[Using numbered paragraphs, set out the grounds of appeal. In unfair dismissal appeals, grounds relating to “significant errors of fact” should be set out under a separate heading.]

Note: Pursuant to s.400(2) of the Act, an appeal from a decision made in relation to an unfair dismissal matter under Part 3-2 of the Act can only, to the extent that it is an appeal on a question of fact, be made on the ground that the decision involved a “significant error of fact”.

3. Public interest in permitting the appeal:

[Set out the matters that the appellant contends make it in the public interest for FWA to grant permission for the appeal.]

Note: s.400(1) prohibits FWA from granting permission for an appeal from a decision made under Part 3-2 of the Act relating to unfair dismissal unless FWA “considers that it is in the public interest to do so”.

4. Stay under s.606:

4.1 Is a stay of the decision sought?

[ ] Yes

[ ] No

4.2 If “Yes”, provide details:

[If a stay is sought, specify whether a stay is sought of the whole or part of the decision or order and, if a stay of part only is sought, specify that part.]

5. Extension of time:

If this Notice of Appeal is lodged later than 21 days after the decision or order under appeal was given or made, application should be made for an extension of time within which to institute this appeal.

5.1 Is an extension of time sought?

[ ] Yes

[ ] No

5.2 If “Yes”, provide details:

[Using numbered paragraphs, set out the grounds on which it is claimed an extension of time should be granted.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This Notice of Appeal must be served on the other parties to the matter at first instance as soon as practicable after this Notice is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F8 Application for FWA to Deal with a General Protections Dispute

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR FWA TO DEAL WITH A GENERAL PROTECTIONS DISPUTE

Fair Work Act 2009—ss.365, 372

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Other parties to the dispute)

Legal name:
Trading name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

The Applicant applies to have FWA deal with a dispute over an alleged contravention of Part 3-1 of the Fair Work Act 2009 by the Respondent.

1. What is the industry of the employer?

[Specify industry.]

2. Alleged contravention(s) of Part 3-1:

2.1 Section(s) allegedly contravened:

[List the section(s) of Part 3-1 that the Respondent is alleged to have contravened. See www.fwa.gov.au/index.cfm?pagename=disputegeneral for assistance in identifying the correct section(s).]

2.2 Description of alleged contravention(s):

[Using numbered paragraphs, give a description of the relevant facts and circumstances and specify how you say the section(s) specified in 2.1 have been contravened by the actions or conduct of the Respondent. This should include your response to any reasons for dismissal given by the employer. Attach additional pages if necessary.]

3. Dismissal:

3.1 Did the alleged contravention involve the dismissal of the Applicant or, where the Applicant is an organisation, an employee whose industrial interests the organisation is entitled to represent?

[ ] Yes

[ ] No

3.2 If “Yes”:

Name of employee dismissed: [Insert name.]
Date employed: [Insert date.]
Date of dismissal: [Insert date.]

3.3 What were the reasons for termination, if any, given by the employer?

[Using numbered paragraphs, specify briefly the reason(s), if any, given by the employer for the termination. Attach any letter of termination and/or separation certificate given by the employer.]

4. For the purposes of participating in a conciliation conference do you think you need an interpreter other than a family member or friend?

[ ] Yes — language: [Insert your first language]

[ ] No

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This form will be served upon the Respondent by FWA.

Notice to the Respondent

A Respondent must, within 7 days of being served with this application, lodge with FWA and serve on the Applicant a response to the application in accordance with Form F8A. A copy of that form can be downloaded at www.fwa.gov.au.

See next page for application fee details.

Application fee

If an application is lodged at a FWA office, the fee can be paid by cash, cheque, money order or credit card (Visa or MasterCard).

If an application is lodged by mail, the fee can be paid by cheque, money order or credit card (in which case, provide credit card details below).

If an application is lodged by fax, the fee must be paid by credit card (provide credit card details below).

[ ] cash

[ ] cheque/money order (to be made payable to: Collector of Public Monies, FWA)

[ ] Visa

[ ] MasterCard

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Card expiry date: __ __ / __ __

Cardholder’s name: ..............................................................................................

Signature: ...............................................................................................................

Any refund of the application fee will be forwarded to the Applicant at the address on the application form.

FWA use only

FWA Matter No.: ..................................................

Receipt No.: .......................................................... / Credit Transaction

Processed by: ........................................................

PLEASE RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS

Form F8A Employer’s Response to Application for FWA to Deal with a General Protections Dispute

(Rule 16A Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA

FWA Matter No: C

[Insert FWA matter number appearing on the main application form.]

Applicant:

[Insert name of Applicant from main application.]

Respondent:

[Insert name of Respondent from main application. If that name is incorrect, insert correct name below.]

EMPLOYER’S RESPONSE TO APPLICATION FOR FWA TO DEAL WITH A GENERAL PROTECTIONS DISPUTE

Respondent (Employer)

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent’s representative (if any)

Name:
Address:
Suburb:	State:		Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Do you agree with the information given in items 1 and 3 of the Form F8 application to which you are responding?

[ ] Yes

[ ] No

2. If “No”, please provide what you contend is the correct information.

3. What is your response to the alleged contravention?*

[Using numbered paragraphs, briefly specify your response to the contraventions alleged in item 2 of the application.]

4. If the Applicant alleges a dismissal, what were the reasons for dismissal?*

[Using numbered paragraphs, briefly specify the reasons. Attach any letter of dismissal and/or separation certificate.]

5. If the Applicant does not allege a dismissal, does the Respondent agree to participate in a conference to deal with the dispute? (see s.374 of the Fair Work Act 2009)

[ ] Yes

[ ] No

Date:
Signature:
Name:
Capacity/Position:

*An employer is not required to provide a response to questions 3 and 4 if the employer is concerned that the response may be self-incriminating.

Service requirements

This Response (including any supporting documentation accompanying the Response) must be lodged with FWA and served on the Applicant within 7 days of being served with the Form F8 application or in accordance with any instruction given by FWA.

Form F9 Application for FWA to Deal with an Unlawful Termination Dispute

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR FWA TO DEAL WITH AN

UNLAWFUL TERMINATION DISPUTE

Fair Work Act 2009—s.773

[If you require information about completing and lodging this form, please go to www.fwa.gov.au or call 1300 799 675.]

Applicant (Employee/Industrial Association)

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent (Employer)

Legal name:
Trading name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

The Applicant applies for FWA to deal with a dispute involving an allegation that the employment of the Applicant, or an employee whose industrial interests the Applicant is entitled to represent, was terminated in contravention of s.772(1).

1. What is the industry of the employer?

[Specify industry.]

2. If the Applicant is not the employee that was terminated, what is the name of the employee whose employment was terminated?

3. What was the date of termination?

4. For the purposes of participating in a conciliation conference do you think you need an interpreter other than a family member or friend?

[ ] Yes — language: [Insert your first language.]

[ ] No

5. What were the reasons for termination, if any, given by the employer?

[Using numbered paragraphs, specify briefly the reason(s), if any, given by the employer for the termination. Attach any letter of termination and/or separation certificate given by the employer.]

6. What is the alleged contravention of s.772(1)?

[Using numbered paragraphs, give a description of the relevant facts and circumstances and specify how you say the termination involved a contravention of s.772(1). This should include your response to any reasons for dismissal given by the employer. Attach additional pages if necessary.]

7. Section 723 provides that a person must not make an unlawful termination application in relation to conduct if the person is able to make a general protections court application in relation to the conduct (see Division 8 of Part 3-1). Do you consider that you cannot make a general protections court application?

[ ] Yes

[ ] No

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This form will be served on the Respondent by FWA.

Notice to the Respondent

A respondent must, within 7 days of being served with this application, lodge with FWA and serve on the Applicant a response to the application in accordance with Form F9A. A copy of that form can be downloaded at www.fwa.gov.au.

See next page for application fee details.

Application fee

If an application is lodged at a FWA office, the fee can be paid by cash, cheque, money order or credit card (Visa or MasterCard).

If an application is lodged by mail, the fee can be paid by cheque, money order or credit card (in which case, provide credit card details below).

If an application is lodged by fax, the fee must be paid by credit card (provide credit card details below).

[ ] cash

[ ] cheque/money order (to be made payable to: Collector of Public Monies, FWA)

[ ] Visa

[ ] MasterCard

Card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __

Card expiry date: __ __ / __ __

Cardholder’s name: ..............................................................................................

Signature: ...............................................................................................................

Any refund of the application fee will be forwarded to the Applicant at the address on the application form.

FWA use only

FWA Matter No.: ...................................................

Receipt No.: ........................................................... / Credit Transaction

Processed by: .........................................................

PLEASE RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS

Form F9A Employer’s Response to Application for FWA to Deal with an Unlawful Termination Dispute

(Rule 16AA Fair Work Australia Rules 2010)

IN FAIR WORK AUSTRALIA

FWA Matter No: C

[Insert FWA matter number appearing on the main application form.]

Applicant:

[Insert name of Applicant from main application.]

Respondent:

[Insert name of Respondent from main application. If that name is incorrect, insert correct name below.]

EMPLOYER’S RESPONSE TO APPLICATION FOR FWA TO DEAL WITH An unlawful termination dispute

Respondent (Employer)

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent’s representative (if any)

Name:
Address:
Suburb:	State:	Postcode:
Contact person:
Telephone:	Mobile:
Fax:	Email:

1. Do you agree with the information given in items 1, 2 and 3 of the Form F9 application to which you are responding?

[ ] Yes

[ ] No

2. If “No”, please provide what you contend is the correct information:

3. What were the reasons for dismissal?

[Using numbered paragraphs, briefly specify the reasons. Attach any letter of dismissal and/or separation certificate.]

4. What is your response to the alleged contravention(s) of s.772(1)?*

[Using numbered paragraphs, briefly specify your response to the contraventions alleged in item 6 of the application.]

Date:
Signature:
Name:
Capacity/Position:

*An employer is not required to provide a response to question 4 if the employer is concerned that the response may be self-incriminating.

Service requirements

This Response (including any supporting documentation accompanying the Response) must be lodged with FWA and served on the Applicant within 7 days of being served with the Form F9 application or in accordance with any instruction given by FWA.

Form F10 Application for FWA to Deal with a Dispute in Accordance with a Dispute Settlement Procedure

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR FWA TO DEAL WITH A DISPUTE IN ACCORDANCE WITH A DISPUTE SETTLEMENT PROCEDURE

Fair Work Act 2009—s.739 etc.*

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Party/Parties with whom the Applicant is in dispute)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Relevant instrument:

The dispute is referred to FWA pursuant to a dispute settlement procedure in:

Name of instrument:

[Also include any ID/Code No. if known.]

Type of instrument:
[Tick the appropriate box.]

[ ]	modern award;
[ ]	enterprise agreement (made under the Fair Work Act 2009 after 1 July 2009);
[ ]	workplace agreement (made under the Workplace Relations Act 1996 after 26 March 2006);
[ ]	certified agreement (made under the Workplace Relations Act 1996 on or before 26 March 2006);
[ ]	AWA, ITEA or an individual preserved state agreement;
[ ]	contract of employment or other written agreement with a procedure for dealing with disputes in relation to the NES or a safety net contractual entitlement;
[ ]	other (please specify):

Please attach a copy of the dispute settlement procedure.

3. Clauses to which the dispute relates:

[List the clause(s) in the relevant instrument (and, if also relevant, the NES) to which the dispute relates.]

4. What is the dispute about?

[Using numbered paragraphs, set out a description of what the dispute is about, including by reference to the clauses set out above.]

5. Does this application relate to a refusal by an employer of a request by an employee for flexible working arrangements?

[ ] Yes

[ ] No

6. Does this application relate to a refusal by an employer of a request by an employee for extension of unpaid parental leave?

[ ] Yes

[ ] No

7. Relief sought:

[If FWA has a power of arbitration, specify the determination(s) sought.]

8. Steps already taken under dispute settlement procedure:

[Set out, in chronological order, the steps already taken (if any) under the dispute settlement procedure.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application (including any supporting documentation lodged with the application) must be served on the named Respondent(s) to the dispute as soon as practicable after the document is lodged with FWA.

Serving a document means giving a copy of the document to the person being served in a manner provided for in the Fair Work Australia Rules 2010. Rule 9 sets out the ways in which a document can be served. For example, to serve a company it is sufficient if a copy of the documents is sent by Express Post (retaining the sender’s copy of the identifying barcode), registered post or delivered by hand, to the company’s registered office or its principal place of business.

*This form should also be used for an application for FWA to deal with a dispute in accordance with a dispute resolution procedure in an agreement made under the Workplace Relations Act 1996 and other transitional instruments (see Schedule 19 of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009).

Form F11 Application for FWA to Deal with a Bargaining Dispute

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR FWA TO DEAL WITH A BARGAINING DISPUTE

Fair Work Act 2009—s.240

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Bargaining representative(s) with whom the Applicant is in dispute)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

Other bargaining representatives

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Course of bargaining:

[Give a brief description of the course of bargaining to date including when bargaining commenced. Attach any notices issued during the course of the bargaining.]

3. What are the main matters in dispute?

[Briefly describe the main matters that remain in dispute.]

4. Other proceedings before FWA:

[List the FWA matter number of any proceedings that have already been before FWA in relation to the present bargaining.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the other party/parties to the dispute and all other bargaining representatives as soon as practicable after the application is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F12 Application for FWA to Deal with a Right of Entry Dispute

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR FWA TO DEAL WITH A

RIGHT OF ENTRY DISPUTE

Fair Work Act 2009—s.505

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Capacity in which the Applicant applies:

[ ] a permit holder;

[ ] a permit holder’s organisation;

[ ] an employer;

[ ] an occupier of premises.

3. What is the dispute about?

[Give a brief summary of what the dispute is about. Include reference to the specific provision(s) of Part 3-4 of the Act the operation of which is in dispute.]

4. Orders sought:

[Set out the orders sought including any order(s) of the sort specified in s.505(2).]

5. Grounds:

[Using numbered paragraphs, set out the grounds, including particulars, upon which the Applicant relies in seeking such relief.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the named Respondent(s) as soon as practicable after the application is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F13 Application for FWA to Deal with a Stand Down Dispute

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR FWA TO DEAL WITH A STAND DOWN DISPUTE

Fair Work Act 2009—s.526

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Capacity in which the Applicant applies:

[Specify, by reference to the categories in s.526(3), the capacity in which the Applicant applies.]

3. What is the dispute about?

[Give a brief summary of what the dispute is about. Include reference to the specific provision(s) of Part 3-5 of the Act the operation of which is in dispute.]

4. Order(s) sought:

[Set out the terms of the order(s) sought.]

5. Grounds:

[Using numbered paragraphs, set out the grounds, including particulars, upon which the Applicant relies in seeking such order(s).]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the named Respondent(s) as soon as practicable after the application is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F14 Application for an Order to Stop etc. (Unprotected) Industrial Action

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR AN ORDER TO STOP ETC. (UNPROTECTED) INDUSTRIAL ACTION

Fair Work Act 2009—ss.418, 419

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Application is made under:

[ ] s.418(2)(b);

[ ] s.419(2)(b).

2. What is the industry of the employer?

[Specify industry.]

3. Persons against whom order(s) sought:

[List the persons, including organisations (and their contact details if known) that the Applicant seeks to be bound by the orders sought. Employees may be listed by name or by describing a class of employees to be bound by the order.]

4. Grounds:

[Using numbered paragraphs, set out the grounds on which the application is made, including details of:

 the industrial action which is happening, or is threatened, impending or probable or is being organised; and

 how the Applicant is a person affected, or likely to be affected (directly or indirectly), by the industrial action.]

5. Order(s) sought:

[Set out, or attach as a separate document, draft orders. An electronic copy of this application and any separate draft order should be sent by email to the chambers of the member who lists the matter for hearing.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on any person who will be bound by the orders sought as soon as is practicable after it is lodged with FWA.

Note: Rules 9 and 10 deal with service. It is open to an applicant to seek an order for substituted service (see rule 10) to avoid the need to individually serve employees who would be bound by the order(s) sought.

Form F16 Application for Approval of Enterprise Agreement

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR APPROVAL OF ENTERPRISE AGREEMENT

Fair Work Act 2009—s.185

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Is the Applicant?
[ ] the employer;
[ ] an employee organisation which was a bargaining representative;
[ ] a bargaining representative appointed by the employer;
[ ] a bargaining representative appointed by an employee;
[ ] other (please specify):

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Is the enterprise agreement:

[ ] a single-enterprise agreement;

[ ] a multi-enterprise agreement.

2. What is the full and precise name of the agreement?

3. Employer

3.1 If the Applicant is not the employer, please provide details of the employer to be covered by the agreement:

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Contact details for the Employer or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

[If the agreement is a multi-enterprise agreement, please include additional boxes or attach a separate sheet identifying each employer covered by the agreement. All of the above details must be provided for each employer.]

3.2 What is the industry of the employer?

[Specify industry.]

4. Bargaining Representative—Employer

Did the employer appoint a bargaining representative? (s.176(1)(d))

[ ] Yes

[ ] No

If “Yes”, provide details of that bargaining representative:

Name:
Address:
Suburb:		State:		Postcode:
Contact person:	[if applicable]
Telephone:			Mobile:
Fax:			Email:

5. Bargaining representative(s)—Union(s)

Were any employee organisations (unions) bargaining representatives for the agreement? (s.176(1)(b) and (3))

[ ] Yes

[ ] No

If “Yes”, provide details of that bargaining representative:

Employee Organisation 1
Name:
	ABN: [If known]
Address:
Suburb:		State:		Postcode:
Contact person:
Telephone:			Mobile:
Fax:			Email:

[If more than one employee organisation was a bargaining representative, please include additional boxes or attach a separate sheet identifying each of the employee organisations which were bargaining representatives for the agreement. Please provide all of the details identified above for each such organisation.]

6. Bargaining Representatives—Employees

6.1 How many instruments of appointment signed by an employee or employees appointing a bargaining representative were given to the employer? (s.176(1)(c) and (4), s.178(2)(a))

6.2 If one or more such instruments were given to the employer, please provide details of each such bargaining representative who is not a union specified above:

Name:
Address:
Suburb:		State:		Postcode:
Contact person:	[if applicable]
Telephone:			Mobile:
Fax:			Email:

[Please include additional boxes or attach a separate sheet identifying each of the (non-union) employee bargaining representatives for the agreement. Please provide all of the details identified above for each such bargaining representative.]

7. Other

7.1 Are the substantive provisions, or most of the substantive provisions, of the agreement based on a template other than an existing agreement applying to the employer?

[ ] Yes

[ ] No

If “Yes”, please provide details of the source of the template:

7.2 Is the Applicant or the Applicant’s representative aware of other agreement(s) in identical or substantially identical terms having been dealt with by FWA?

[ ] Yes

[ ] No

If “Yes”, please provide information that would assist in identifying such agreement(s) (e.g. identification number and date of FWA’s decision, the name of such agreement, the name of the member of FWA who dealt with such agreement or the name of the employer covered by such agreement):

Date:
Signature:
Name:
Capacity/Position:

Service requirements

A copy of this application must be served on each employer covered by the agreement, each employee organisation that was a bargaining representative and any other employee bargaining representative of which the Applicant is aware, as soon as practicable after the application is lodged.

A copy of this application must also be brought to the attention of employees covered by the agreement through the usual means adopted by the employer(s) for communicating with employees e.g. posting on employee notice boards or by email to employees where this is the usual method.

Note: Rules 9 and 10 deal with service.

Other requirements

The application must be accompanied by declarations completed by an officer or employee of each employer covered by the agreement and an officer or employee of each employee organisation which was a bargaining representative for the agreement and which support the application. These declarations may be found at:

 Form F17 for employer declarations; and

 Form F18 for employee organisation declarations.

When lodging this application, the application must be accompanied by:

 a signed copy of the agreement (see s.185(2)(a)); and

 sufficient additional copies to enable a copy to be provided to each bargaining representative in the event of approval by FWA.

Note: A copy of an enterprise agreement is a signed copy only if:

(a) it is signed by:

(i) the employer covered by the agreement; and

(ii) at least 1 representative of the employees covered by the agreement; and

(b) it includes:

(i) the full name and address of each person who signs the agreement; and

(ii) an explanation of the person’s authority to sign the agreement.

(See reg. 2.06A of the Fair Work Regulations 2009.)

Form F17 Employer’s Declaration in Support of Application for Approval of Enterprise Agreement

IN FAIR WORK AUSTRALIA

FWA Matter No.:

[Insert FWA matter number appearing on the main application form, if known.]

Applicant:

[Insert name of Applicant from main application.]

EMPLOYER’S DECLARATION IN SUPPORT OF APPLICATION FOR APPROVAL OF ENTERPRISE AGREEMENT

Fair Work Act 2009—s.185

Note: This declaration must be made by an officer or employee of the employer.

[name]

[address]

[occupation]

Make the following declaration under the Statutory Declarations Act 1959:

Part 1: Preliminary

1.1 Full and precise name of Agreement:

1.2 Legal name of Employer:

1.3 Trading name of Employer (if different):

1.4 Are you aware of other agreement(s) in identical or substantially identical terms having been dealt with by FWA?

[ ] Yes

[ ] No

1.5 Has a scope order or a low-paid authorisation been issued in relation to the Agreement?

[ ] Yes

[ ] No

If “Yes”, please provide the unique print number and date of the order:

PR __ __ __ __ __ __

Date: __ __ / __ __ / __ __

Part 2: Requirements for approval

Nominal Expiry Date (s.186(5))

2.1 What is the nominal expiry date of the Agreement and the clause number of the clause that specifies that date: (s.186(5))?

Scope of the Agreement (s.186(3) and (3A))

2.2 Does the Agreement cover all employees of the Employer (other than senior executives)?

[ ] Yes

[ ] No

2.3 If “No”, specify the group(s) of employees covered by the Agreement and how FWA can be satisfied that such group(s) were fairly chosen, including, if appropriate, by reference to the geographical, operational or organisational distinctness of such group(s): (s.186(3) and (3A)):

Agreement Genuinely Approved - (s.186(2)(a), s.188, s.180(2), (3) and (5), s.181)

2.4 Did the employer take all reasonable steps to give notice of the right to be represented by a bargaining representative to each employee who will be covered by the Agreement as required by s. 173?

[ ] Yes

[ ] No

If “Yes”, please attach a copy of the notice given to employees and explain the steps taken:

Note The notice required by s. 173 must meet the relevant requirements of s. 174. A form of notice has been prescribed and can be found in Schedule 2.1 to the Fair Work Regulations 2009 at http://www.comlaw.gov.au/Series/F2009L02356.

2.5 Please specify the steps taken by the employer to ensure that the relevant employees were given, or had access to, the written text of the Agreement and any other material incorporated by reference into the Agreement during the 7 day period ending immediately before the start of the voting process (s.180(2)(a)):

2.6 Please specify the steps taken by the employer (including the date of each such step) to notify all relevant employees of the time and place at which the vote was to occur and the voting method to be used (s.180(3)):

2.7 Please specify the steps taken by the employer to explain the terms of the Agreement, and the effect of those terms, to relevant employees (s.180(5)):

[Note: Your answer must include information on the manner in which the explanation took account of particular circumstances and needs of the relevant employees. (e.g., where the employees were from a non-English speaking background, were young employees or did not have a bargaining representative).]

2.8 Please provide the following dates:

Date on which the last notice of representational rights was given to an employee who will be covered by the Agreement (s.181(2)):
Date on which voting for the Agreement commenced (voting commences on the first day that an employee is able to cast a vote — see s.181):
Date on which the Agreement was made (that is, the date on which the voting process by which employees approved the agreement concluded — see s.182):

If the date on which the Agreement was made is more than 14 days before the date on which application for approval of the Agreement was lodged, please provide details of the circumstances which FWA should take into account in deciding if it is fair to extend the time for lodging the application (s.185(3)(b)):

2.9 Please provide the following details of the vote on the Agreement:

Number of employees who will be covered by the Agreement:
Number of employees who cast a valid vote:
Number of employees who voted to approve the Agreement:

Interaction with National Employment Standards (s.186(2)(c))

2.10 Please list any terms of the Agreement that exclude in whole, or in part, the National Employment Standards:

2.11 Please identify any terms of the Agreement that are detrimental to an employee in any respect when compared to the National Employment Standards:

Unlawful Terms (s.186(4))

2.12 Does the Agreement contain any terms that deal with the rights of officials or employees of employee organisations to enter the employer’s premises? (s.186(4) and s.194(f) and (g))

[ ] Yes

[ ] No

If “Yes”, please specify the term(s):

2.13 Does the Agreement contain any:

discriminatory terms? (s.186(4) and s.194(a), s.195);
objectionable terms? (s.186(4) and s.194(b), definition in s.12);
terms that deal with the rights of employees in relation to unfair dismissal? (s.186(4) and s.194(c) and (d));
terms that deal with the taking of industrial action that are inconsistent with Part 3-3 of Chapter 3 of the Act? (s.186(4) and s.194(e)); or
designated outworker terms? (s.186(4A))

[ ] Yes

[ ] No

Required terms

2.14 Please specify the clause number of the following required terms:

Dispute Resolution Procedure (s.186(6)):
Flexibility Term (s.202(1), s.203):
Consultation Term (s.205(1)):

Particular types of workers

2.15 Does the Agreement cover any shiftworkers? (s.196)

[ ] Yes

[ ] No

If “Yes”, please identify the clause, if any, that defines or describes an employee as a shiftworker for the purposes of the National Employment Standards:

2.16 Does the Agreement:

cover any pieceworkers (s.197); or
contain terms providing for school-based apprentices or trainees to receive loadings in lieu of paid leave (s.199); or
cover any outworkers (s.200)?

[ ] Yes

[ ] No

If “Yes”, please identify the relevant clause(s):

Part 3: Better Off Overall Test

It is essential that you set out the names of any modern award(s) or award‑based transitional instrument(s) — typically pre-reform award(s) or NAPSAs — accurately in full and include the “MA”, “AP” or “AN” number of each such instrument. These numbers can be located via a title search on the “Find an award” search facility at:

http://www.fwa.gov.au/index.cfm?pagename=awardsfind.

Under the legislative scheme an award will not apply to employees if a statutory collective agreement is in place. However, an award that would apply in the absence of such an agreement will still cover those employees.]

Reference instrument(s)

3.1 Relevant modern award(s)

List the modern award(s), if any, that currently cover the employer in relation to any employees covered by this Agreement:

3.2 Relevant pre-reform award(s)/NAPSA(s)

List the pre-reform award(s) or NAPSA(s), if any, that covered the employer in relation to any employees covered by this Agreement as at 31 December 2009:

Translating classifications

3.3 If the classifications in the Agreement are different from the classifications in any of the reference instrument(s) listed in questions 3.1 and 3.2, please attach a table that identifies how classifications in the Agreement relate to classifications in the reference instrument(s).

Improvements/reductions

3.4 Does the Agreement contain any terms or conditions of employment that are more beneficial than equivalent terms and conditions in the reference instrument(s) listed in questions 3.1 and 3.2 or does the Agreement confer any entitlements that are not conferred by those reference instrument(s)?

[ ] Yes

[ ] No

3.5 If “Yes”, identify the terms and conditions in the Agreement that:

(a) are more beneficial than the reference instrument(s),

(b) are not conferred by the reference instrument(s),

together with the employees affected and the relevant terms of the reference instrument(s):

3.6 Does the Agreement contain any terms or conditions of employment that are less beneficial than equivalent terms and conditions in the reference instrument(s) listed in questions 3.1 and 3.2 or do those reference instrument(s) confer any entitlements that are not conferred by the Agreement?

[ ] Yes

[ ] No

3.7 If “Yes”, identify the terms and conditions in the reference instrument(s) that:

(a) are more beneficial than the Agreement; or

(b) are not conferred by the Agreement,

together with the employees affected and, in the case of (a), the relevant terms of the Agreement:

[Note: your answers to 3.5 and 3.7 should indicate whether all or only some of the employees are affected and, if only some employees are affected, identify the group(s) of employees affected.]

Exceptional circumstances (agreement fails the better off overall test)

3.8 If the employer considers that the Agreement does not pass the better off overall test as set out at s.193 of the Fair Work Act 2009 (and, possibly, item 18 of Schedule 7 to the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009), identify any exceptional circumstances that FWA should consider when deciding whether approving the Agreement would not be contrary to the public interest (s.189):

Part 4: Statistical information

Note: The information in this part is necessary to enable Fair Work Australia to comply with its statutory reporting obligations.

4.1 Of the employees covered by the Agreement, how many employees are in the following demographic groups?

Group	Number of employees within group
Female
Non-English speaking background
Aboriginal or Torres Strait Islander
Disabled
Part-time
Casual
Under 21 years of age
Over 45 years of age (mature age)

4.2 In what State/Territory will the Agreement be in operation?

[Mark all applicable boxes with an “X”.]

ACT

[ ]

NSW

[ ]

Qld

[ ]

Tas

[ ]

Vic

[ ]

4.3 Please list the full and precise name of all collective agreements (including any ID number, if known,) that covered any employees covered by this Agreement immediately prior to the time this Agreement was made:

4.4 What is the primary activity of the employer?

[e.g. music retailer, plumbing contractor, steel fabricator.]

I understand that a person who intentionally makes a false statement in a statutory declaration is guilty of an offence under section 11 of the Statutory Declarations Act 1959, and I believe that the statements in this declaration are true in every particular.

[Signature of person making the declaration.]

Declared at:

[place]

On:

[date]

Before me:

[Signature of person before whom the declaration is made.]

[Set out the witness’ full name, qualification to witness a statutory declaration and address (all in printed letters). Note: A statutory declaration must be made before a “prescribed person”: s.8, Statutory Declarations Act 1959 (Cth). For a full description of prescribed persons, go to fwa.gov.au/index.cfm?pagename=resourcefactsstatdecs.]

Please provide your contact details for any future inquiries related to this declaration:

Name:
Address:
Suburb:	State:	Postcode:
Telephone:	Mobile:
Fax:	Email:

Form F18 Declaration of Employee Organisation in relation to an Application for Approval of Enterprise Agreement

IN FAIR WORK AUSTRALIA

FWA Matter No.:

[Insert FWA matter number appearing on the main application form, if known.]

Applicant:

[Insert name of Applicant from main application.]

DECLARATION OF EMPLOYEE ORGANISATION IN RELATION TO AN APPLICATION FOR APPROVAL OF ENTERPRISE AGREEMENT

Fair Work Act 2009—s.185

[name]

[address]

[occupation]

Make the following declaration under the Statutory Declarations Act 1959:

1. I am an officer of the [name of employee organisation] (the Union).

2. This declaration relates to an application for approval of an enterprise agreement (the Agreement), as follows:

Name of Agreement:

Name of Employer(s) to be covered by the agreement:

FWA matter number of the Application for Approval:

3. The Union was a bargaining representative for the Agreement because one or more members of the Union are employees who are covered by the Agreement and the Union is entitled to represent the industrial interests of those employees in accordance with s.176(1)(b) of the Fair Work Act 2009.

4. The Union supports the approval of the Agreement by Fair Work Australia?

[ ] Yes

[ ] No

5. If the answer to question 4 is “No”, the grounds of objection raised by the Union are as follows:

[Using numbered paragraphs, set out the matters of disagreement. Attach additional pages if necessary or set out as an attachment.]

6. I have read the employer’s Form F17 statutory declaration in support of the Application. In so far as the matters contained in that statutory declaration are within my knowledge:

[ ] I agree with that statutory declaration.

[ ] I disagree with one or more of the answers given to questions in the statutory declaration, or with other matters specified in the statutory declaration, as follows:

[Using numbered paragraphs, set out the matters of disagreement. Attach additional pages if necessary or set out as an attachment.]

7. The Union gives notice pursuant to s.183 of the Fair Work Act 2009 that it wants to be covered by the Agreement?

[ ] Yes

[ ] No

[Signature of person making the declaration.]

Declared at:

[place]

On:

[date]

Before me:

[Signature of person before whom the declaration is made.]

fwa.gov.au/index.cfm?pagename=resourcefactsstatdecs.]

Please provide your contact details for any future inquiries related to this declaration:

Name:
Address:
Suburb:	State:	Postcode:
Telephone:	Mobile:
Fax:	Email:

Service requirements

This declaration must be served on the employer(s) to be covered by the Agreement and any other relevant bargaining representative known to the Union as soon as practicable after the document is lodged with FWA.

Note 1: Rule 9 deals with service.

Note 2: An employee organisation that wants to be covered by the Agreement must lodge this declaration (with Question 7 answered ‘Yes’) with Fair Work Australia, or otherwise give notice in accordance with s.183 of the Act, before Fair Work Australia approves the Agreement.

Form F19 Application for Approval of Greenfields Agreement

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR APPROVAL OF GREENFIELDS AGREEMENT

Fair Work Act 2009—s.185

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Is the Applicant?
[ ] an employer covered by the agreement;
[ ] an employee organisation that is covered by the agreement.

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Is the greenfields agreement:

[ ] a single-enterprise agreement;

[ ] a multi-enterprise agreement.

2. What is the full and precise name of the agreement?

3. What is the industry of the employer?

[Specify industry.]

4. Please provide details of the employer to be covered by the agreement:

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

5. Please provide details of each employee organisation that is covered by the agreement:

Employee Organisation 1
Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

[If the agreement covers more than one employee organisation, please include additional boxes for each organisation.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

A copy of this application must be served on each employer and each employee organisation covered by the agreement, as soon as practicable after the application is lodged.

Note: Rules 9 and 10 deal with service.

Other requirements

When lodging this application, the Applicant must ensure that it is accompanied by declarations completed by an officer or employee of each employer and an officer or employee of each employee organisation that the agreement is expressed to cover. These declarations may be found at:

 Form F20 for employer declarations; and

 Form F21 for employee organisation declarations.

When lodging this application, it must be accompanied by:

 a signed copy of the agreement (see s.185(2)(a)); and

 sufficient additional copies to enable a copy to be provided to each bargaining representative in the event of approval by FWA.

Form F20 Employer’s Declaration in Support of Application for Approval of Greenfields Agreement

IN FAIR WORK AUSTRALIA

FWA Matter No.:

[Insert FWA matter number appearing on the main application form, if known.]

Applicant:

[Insert name of Applicant from main application.]

EMPLOYER’S DECLARATION IN SUPPORT OF APPLICATION FOR APPROVAL OF GREENFIELDS AGREEMENT

Fair Work Act 2009—s.185

Note: This declaration must be made by an officer or employee of the employer.

[name]

[address]

[occupation]

Make the following declaration under the Statutory Declarations Act 1959:

Part 1: About the greenfields business to be covered

1.1 What is the name of the agreement?

1.2 What is the name of the employer or employers to be covered by the agreement?

1.3 What is the name and address of each business of each employer covered by the agreement?

1.4 What kind of work will be done under the agreement?

1.5 Does the agreement cover a genuine new enterprise the employer is establishing or is proposing to establish?

[ ] Yes

[ ] No

1.6 As at the date the agreement was made, had the employer employed any persons who will be necessary for the normal conduct of the new business and will be covered by the agreement?

[ ] Yes

[ ] No

Part 2: Requirements for approval

2.1 Please specify the date on which the agreement was made: (s.182(3))

2.2 If the agreement is a multi-enterprise agreement, has each employer who will be covered by the agreement genuinely agreed to the making of the agreement and done so free from coercion or threats of coercion to make the agreement?: (s.186(2)(b))

[ ] Yes

[ ] No

2.3 Does the agreement cover all prospective employees of the employer or employers?

[ ] Yes

[ ] No

2.4 If “No”, please provide details of the geographical, operational or organisational basis for choosing the group(s) of prospective employees to be covered by the agreement: (s.186(3))

2.5 Are the employee organisations that will be covered by the agreement, taken as a group, entitled to represent the industrial interests of a majority of the employees who will be covered by the agreement, in relation to work to be performed under the agreement? (s.187(5)(a))

[ ] Yes

[ ] No

2.6 Please provide details of how the approval of the agreement would be in the public interest: (s.187(5)(b))

2.7 Please identify any terms of the agreement that deal with the matters contained in the National Employment Standards: (s.186(2)(c))

2.8 Please identify any terms of the agreement that exclude in whole, or in part, the National Employment Standards:

2.9 Please identify any terms of the agreement that are detrimental to an employee in any respect when compared to the National Employment Standards:

2.10 Does the agreement contain any discriminatory terms? (s.194(a))

[ ] Yes

[ ] No

If “Yes”, please identify the relevant terms of the agreement:

2.11 Does the agreement contain any objectionable terms? (s.194(b))

[ ] Yes

[ ] No

If “Yes”, please identify the relevant terms of the agreement:

2.12 Does the agreement contain any terms that deal with the rights of employees in relation to unfair dismissal? (s.194(c) and (d))

[ ] Yes

[ ] No

If “Yes”, please identify the relevant terms of the agreement:

2.13 Does the agreement contain any terms that deal with the taking of industrial action and that are inconsistent with Part 3-3 of Chapter 3 of the Act? (s.194(e))

[ ] Yes

[ ] No

If “Yes”, please identify the relevant terms of the agreement:

2.14 Does the agreement contain any terms that deal with the rights of officials of organisations to enter the employer’s premises? (s.194(f) and (g))

[ ] Yes

[ ] No

If “Yes”, please identify the relevant terms of the agreement:

2.15 Does the agreement contain any designated outworker terms? (s.186(4A))

[ ] Yes

[ ] No

If “Yes”, please identify the relevant terms of the agreement:

2.16 Please identify the term of the agreement which specifies the nominal expiry date of the agreement: (s.186(5))

2.17 Please identify the term of the agreement which specifies a procedure for FWA, or another independent person, to settle disputes about any matter arising under the agreement and any dispute in relation to the National Employment Standards: (s.186(6))

2.18 Does the term identified in question 2.17 allow for the representation of employees covered by the agreement for the purposes of the dispute settling procedure? (s.186(6))

[ ] Yes

[ ] No

2.19 Does the agreement cover any shiftworkers? (s.196)

[ ] Yes

[ ] No

If “Yes”, please identify any terms of the agreement that describe the employees as shiftworkers:

2.20 Does the agreement cover any pieceworkers? (ss.197 and 198)

[ ] Yes

[ ] No

If “Yes”, please identify any terms of the agreement that deal with entitlements of pieceworkers:

2.21 Does the agreement contain terms providing for school-based apprentices or trainees to receive loadings in lieu of paid leave? (s.199)

[ ] Yes

[ ] No

If “Yes”, please identify any terms of the agreement that deal with such loadings:

2.22 Does the agreement cover employee outworkers? (s.200)

[ ] Yes

[ ] No

If “Yes”, please identify any terms of the agreement that deal with entitlements of employee outworkers:

2.23 Please identify the flexibility term in the agreement: (ss.202, 203, 204)

2.24 Please identify the consultation term in the agreement: (s.205(1))

Part 3: Comparison data

Reference instrument(s)

[FWA must apply the better off overall test to the agreement by reference to relevant instrument(s): see s.193 of the Fair Work Act 2009 and item 18 in Schedule 7 to the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009. It is essential that you set out the names of any modern award(s) or award-based transitional instrument(s) — typically pre-reform award(s) or NAPSAs — accurately in full and include the “MA”, “AP” or “AN” number of each such instrument. These numbers can be located via a title search on the “Find an award” search facility at:

http://www.fwa.gov.au/index.cfm?pagename=awardsfind.]

3.1 List the modern award(s) and award-based transitional instrument(s) (e.g. pre-reform awards or NAPSAs), if any, that would cover or apply to the employer and the whole or any portion of the prospective employees to whom the agreement will apply:

3.2 If the classifications in the agreement are different from the classifications in any of the reference instrument(s) named in 3.1, please attach a table that identifies how classifications in the agreement relate to classifications in the reference instrument(s).

Improvements/reductions

3.3 Does the agreement contain any terms or conditions of employment that are less beneficial than equivalent terms and conditions in the reference instrument(s) identified in questions 3.1 or 3.2?

[ ] Yes

[ ] No

If “Yes”, identify the terms and conditions in the reference instrument(s) that are more beneficial than the agreement, the employees affected and the specific terms in the agreement that bring about the reductions:

[Note: your answer must indicate whether all or only some of the prospective employees are affected and, if only some employees are affected, identify the group(s) of prospective employees affected.]

3.4 Does the agreement contain any terms or conditions of employment that are more beneficial than equivalent terms and conditions in the reference instrument(s) identified in questions 3.1 or 3.2?

[ ] Yes

[ ] No

If “Yes”, identify the terms and conditions in the reference instrument(s) that are less beneficial than the agreement, the employees affected and the specific terms in the agreement that bring about the improvements:

[Note: your answer must indicate whether all or only some of the prospective employees are affected and, if only some employees are affected, identify the group(s) of prospective employees affected.]

Part 4: Statistical information

4.1 In what State/Territory will the agreement be in operation?

[Mark all applicable boxes with an “X”.]

ACT

[ ]

NSW

[ ]

Qld

[ ]

Tas

[ ]

Vic

[ ]

4.2 What is the primary activity of the employer?

[e.g. music retailer, plumbing contractor, steel fabricator.]

[Signature of person making the declaration.]

Declared at:

[place]

On:

[date]

Before me:

[Signature of person before whom the declaration is made.]

http://www.fwa.gov.au/index.cfm?pagename=resourcefactsstatdecs.]

Please provide your contact details for any future inquiries related to this declaration:

Form F21 Declaration of Employee Organisation in Support of Application for Approval of Greenfields Agreement

IN FAIR WORK AUSTRALIA

FWA Matter No.:

[Insert FWA matter number appearing on main application form, if known.]

Applicant:

[Insert name of Applicant from main application.]

DECLARATION OF EMPLOYEE ORGANISATION IN SUPPORT OF APPLICATION FOR APPROVAL OF GREENFIELDS AGREEMENT

Fair Work Act 2009—s.185

[name]

[address]

[occupation]

Make the following declaration under the Statutory Declarations Act 1959:

1. What is the name of the agreement?

2. What is the name of the employer or employers to be covered by the agreement?

3. Is your organisation entitled to represent the industrial interests of employees who will be covered by the agreement?

[ ] Yes

[ ] No

4. Are the employee organisations that will be covered by the agreement, when taken as a group, entitled to represent the industrial interests of a majority of the employees who will be covered by the agreement, in relation to work to be performed under the agreement? (s.187(5)(a))

[ ] Yes

[ ] No

5. Please provide details of how the approval of the agreement would be in the public interest: (s.187(5)(b))

[Signature of person making the declaration.]

Declared at:

[place]

On:

[date]

Before me:

[Signature of person before whom the declaration is made.]

http://www.fwa.gov.au/index.cfm?pagename=resourcefactsstatdecs.]

Please provide your contact details for any future inquiries related to this declaration:

Form F23 Application for Approval of Variation of Enterprise Agreement

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR APPROVAL OF VARIATION OF ENTERPRISE AGREEMENT

Fair Work Act 2009—s.210

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Is the Applicant?
[ ] an employer covered by the agreement;
[ ] an employee organisation covered by the agreement;
[ ] an employee covered by the agreement.

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. What is the full and precise name of the agreement that was varied?

[Also include the Agreement ID/Code No. if known.]

2. If the applicant is not the employer, please provide details of the employer covered by the agreement:

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

[If the agreement to be varied is a multi-enterprise agreement, please include additional boxes or attach a separate sheet identifying each of the employers which were bargaining representatives to the agreement. All of the above details must be provided for each employer.]

3. Please provide details of any employee organisations covered by the agreement:

Employee Organisation 1
Name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

[If more than one employee organisation is covered by the agreement to be varied, please include additional boxes or attach a separate sheet identifying each employee organisation covered by the agreement. Please provide all of the details identified above for each organisation.]

4. Please specify the date on which the variation was made: (s.210(3)(a))

5. If the date specified in question 4 is more than 14 days before this application for approval of the variation was lodged, please provide details of the circumstances which you say FWA should take into account in deciding if it is fair to extend the time for lodging this application: (s.210(3)(b))

Date:
Signature:
Name:
Capacity/Position:

Service requirements

A copy of this application must be served on each employer and each employee organisation covered by the agreement, as soon as practicable after the application is lodged.

Note: Rules 9 and 10 deal with service.

Other requirements

The application must be accompanied by declarations completed by an officer or employee of each employer covered by the agreement and an officer or employee of each employee organisation which was a bargaining representative for the variation agreement and which supports the application. These declarations may be found at:

Form 23A for employer declarations; and

Form 23B for employee organisation declarations.

When lodging this application, the application must be accompanied by:

a copy of the variation signed by each employer and each employee organisation covered by the variation agreement; and

a copy of the agreement incorporating the proposed variations (with the variations highlighted).

Note: A copy of a variation to an enterprise agreement is a signed copy only if:

(a) it is signed by:

(i) the employer covered by the agreement as varied; and

(ii) at least 1 representative of the employees covered by the agreement as varied; and

(b) it includes:

(i) the full name and address of each person who signs the variation; and

(ii) an explanation of the person’s authority to sign the variation.

(See reg. 2.09A of the Fair Work Regulations 2009.)

Form F23A Employer’s Declaration in Support of Approval of Variation of Enterprise Agreement

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

FWA Matter No.:

[Insert FWA matter number appearing on main application form, if known.]

Applicant:

[Insert name of Applicant from main application.]

EMPLOYER’S DECLARATION IN SUPPORT OF APPLICATION FOR APPROVAL OF VARIATION OF ENTERPRISE AGREEMENT

Fair Work Act 2009—s.210

[name]

[address]

[occupation]

Make the following declaration under the Statutory Declarations Act 1959:

Part 1: About the agreement

1.1 What is the name of the agreement that was varied?

1.2 Is the agreement varying a single-enterprise agreement or a multi-enterprise agreement?

[ ] single-enterprise agreement;

[ ] multi-enterprise agreement.

1.3 What is the name of the employer or employers to be covered by the agreement?

1.4 What is the name and address of the business or businesses of the employer or employers covered by the agreement?

Part 2: Requirements for approval

2.1 Does the variation affect all employers covered by the agreement?

[ ] Yes

[ ] No

If “No”, please describe the employees affected by the variation and how FWA can be satisfied that such group(s) were fairly chosen, including by reference to the geographical, operational or organisational distinctness of such group(s): (s.211(3) and 186(2)(a))

2.2 What was the date on which the variation was made (that is, the date on which the voting process by which affected employees approved the variation) concluded? (s.208)

2.3 If the date specified in question 2.2 is more than 14 days before the application for approval of the variation was lodged, please provide details of the circumstances which FWA should take into account in deciding if it is fair to extend the time for lodging the application: (s.210(3)(b))

2.4 Please specify the steps taken by the employer to ensure that the affected employees were given, or had access to, the written text of the variation and any other material incorporated by reference in the variation during the 7 day period ending immediately before the start of the voting process: (ss.211(3) and 180 (2)(a))

2.5 Please specify the steps taken by the employer (at least 7 days before the start of the voting process) to notify all affected employees of the time and place at which the vote was to occur and the voting method to be used: (ss.211(3) and 180(3))

2.6 Please specify the steps taken by the employer to explain the terms of the variation, and the effect of those terms, to relevant employees: (ss.211(3) and 180(5))

[Note: Your answer must include information on the manner in which the explanation took account of particular circumstances and needs of the affected employees (e.g., where the employees were from a non-English speaking background, were young employees or did not have a bargaining representative).]

2.7 Please provide the following details of the vote on the variation:

Number of employees who are affected by the variation:
Number of employees who cast a valid vote:
Number of employees who voted to approve the variation:

2.8 Please identify any terms of the variation that deal with the matters contained in the National Employment Standards:

2.9 Please identify any terms of the variation that exclude, in whole or in part, the National Employment Standards:

2.10 Please identify any terms of the variation that are detrimental to an employee in any respect when compared to the National Employment Standards:

Part 3: Comparison data

Reference instrument(s)

3.1 List the modern award(s) and award-based transitional instrument(s) (e.g., pre-reform awards or NAPSAs), if any, that cover or apply to the employer and the whole or any portion of the employees to whom the variation will apply:

3.2 For the purposes of enabling FWA to apply the better off overall test in the context of transitional provisions in a modern award, list the award-based transitional instrument(s) (e.g., pre-reform awards or NAPSAs), if any, that covered the employer and the whole or any portion of the employees immediately before the commencement of any modern award referred to in 3.1:

3.3 If the classifications in the agreement are altered by the variation, please attach a table that identifies how classifications in the agreement as varied relate to classifications in the reference instrument(s) named in 3.1 and 3.2.

Improvements/reductions

3.4 Does the variation make any terms or conditions of employment less beneficial than they were before the agreement was varied?

[ ] Yes

[ ] No

If “Yes”, please identify how (including by reference to clause numbers in the variation and clause numbers in the agreement before it was varied):

3.5 Does the variation make any terms or conditions of employment more beneficial than they were before the agreement was varied?

[ ] Yes

[ ] No

If “Yes”, please identify how (including by reference to clause numbers in the variation and clause numbers in the agreement before it was varied):

3.6 Does the agreement as varied contain any terms or conditions of employment that are less beneficial than equivalent terms and conditions in the reference instrument(s) listed in questions 3.1 and 3.2?

[ ] Yes

[ ] No

If “Yes”, identify the terms and conditions in the reference instrument(s) that are more beneficial than the agreement and the specific terms in the agreement that bring about the reductions:

3.7 Does the agreement as varied contain any terms or conditions of employment that are more beneficial than equivalent terms and conditions in the reference instrument(s) listed in questions 3.1 and 3.2?

[ ] Yes

[ ] No

If “Yes”, identify the terms and conditions in the reference instrument(s) that are less beneficial than the agreement and the specific terms in the agreement that bring about the improvements:

Part 4: Other

4.1 Of the employees affected by the variation, how many are in the following demographic groups?

Group	Number of affected employees within group
Female
Non-English speaking background
Aboriginal or Torres Strait Islander
Disabled
Part-time
Casual
Under 21 years of age
Over 45 years of age (mature age)

[Signature of person making the declaration.]

Declared at:

[place]

On:

[date]

Before me:

[Signature of person before whom the declaration is made.]

http://www. fwa.gov.au/index.cfm?pagename=resourcefactsstatdecs.]

Please provide your contact details for any future inquiries related to this declaration:

Name:
Address:
Suburb:	State:	Postcode:
Telephone:	Mobile:
Fax:	Email:

Form F23B Declaration of Employee Organisation in Support of Application for Approval of Variation of Enterprise Agreement

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

FWA Matter No.:

[Insert FWA matter number appearing on main application form, if known.]

Applicant:

[Insert name of Applicant from main application.]

DECLARATION OF EMPLOYEE ORGANISATION IN SUPPORT OF APPLICATION FOR APPROVAL OF VARIATION OF ENTERPRISE AGREEMENT

Fair Work Act 2009—s.210

[name]

[address]

[occupation]

Make the following declaration under the Statutory Declarations Act 1959:

1. The employee organisation on whose behalf I make this declaration (Union) is:

2. This declaration relates to a variation of the following enterprise agreement:

3. What is the name of the employer or employers covered by the agreement?

4. Was the Union a bargaining representative for one or more members of the Union who are also employees covered by the agreement as varied?

5. Is the Union entitled to represent the industrial interests of the employee or employees referred to in question 3 in relation to work that will be performed under the agreement as varied?

[ ] Yes

[ ] No

6. Have you read the statutory declaration lodged on behalf of the employer or employers?

[ ] Yes

[ ] No

7. In so far as the matters contained in the statutory declaration are within your knowledge, do you agree with the answers given to each question addressed in the statutory declaration?

[ ] Yes

[ ] No

8. If “No”, please identify the relevant statutory declaration and the question or questions and provide your answers:

[Signature of person making the declaration.]

Declared at:

[place]

On:

[date]

Before me:

[Signature of person before whom the declaration is made.]

http://www. fwa.gov.au/index.cfm?pagename=resourcefactsstatdecs.]

Please provide your contact details for any future inquiries related to this declaration:

Name:
Address:
Suburb:	State:	Postcode:
Telephone:	Mobile:
Fax:	Email:

Form F24 Application for Termination of Enterprise Agreement

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR TERMINATION OF ENTERPRISE AGREEMENT

Fair Work Act 2009—ss.222, 225

Applicant

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Is the Applicant:
[ ] an employer covered by the agreement;
[ ] an employee organisation covered by the agreement;
[ ] an employee covered by the agreement.

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Application is made for:

[ ] termination of an enterprise agreement (s.222);

[ ] termination of an enterprise agreement after its nominal expiry date (s.225).

2. What is the full and precise name of the agreement to be terminated?

[Also include the Agreement ID/Code No. if known.]

3. What is the nominal expiry date of that agreement?

4. Please provide details of the employer covered by the agreement:

Legal name:
Trading name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

5. Please provide details of any employee organisations covered by the agreement:

Employee Organisation 1
Name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

[If the agreement covers more than one employee organisation, please include additional boxes or attach a separate sheet identifying each employee organisation covered by the agreement. Please provide all of the details identified above for each organisation.]

6. If this application is made under s.222 of the Act, please specify the date when the termination of this agreement was agreed to: (s.221)

7. If the date specified in question 6 is more than 14 days before this application for termination of the agreement was lodged, please provide details of the circumstances FWA should take into account in deciding if it is fair to extend the date for lodging this application:

Date:
Signature:
Name:
Capacity/Position:

Evidence requirements

If the application is made under s.222, this application must be accompanied by a statutory declaration made by an appropriate person authorised by the Applicant (an officer or employee of the employer or employee organisation as the case may be) demonstrating how each of the requirements in s.223 are satisfied.

Service requirements

A copy of this application must be served on each employer and each employee organisation covered by the agreement, as soon as practicable after the application is lodged.

Note: Rules 9 and 10 deal with service.

Form F25 Application to Vary Transitional Instrument to Remove Ambiguities etc.

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION TO VARY TRANSITIONAL INSTRUMENT TO REMOVE AMBIGUITIES ETC.

Fair Work (Transitional Provisions and Consequential Amendments)
Act 2009—item 10 of Schedule 3

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. What is the name of the transitional instrument?

[Also include any ID/Code No. if known.]

3. Indicate the clauses of Schedule 3 to the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009 relied upon to make this application:

[ ] Schedule 3, item 10, paragraph 1(a);

[ ] Schedule 3, item 10, paragraph 1(b);

[ ] Schedule 3, item 10, paragraph 1(c).

4. Variation(s) sought:

[Set out the terms of the variation(s) sought.]

5. Grounds:

[Using numbered paragraphs, set out the grounds upon which the Applicant relies in seeking the variation.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

A copy of this application must be served on all persons bound by, or parties to, the transitional instrument as soon as practicable after the application is lodged.

Note: Rules 9 and 10 deal with service.

Form F28 Application for Termination of Collective Agreement-based Transitional Instrument

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR TERMINATION OF COLLECTIVE AGREEMENT-BASED TRANSITIONAL INSTRUMENT

Fair Work (Transitional Provisions and Consequential Amendments)
Act 2009—items 15 and 16 of Schedule 3

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Application is made under:

[ ] subdivision C of Division 7 of Part 2-4 of the Fair Work Act 2009 as it applies under item 15 of Schedule 3 of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009 for approval for the termination of the abovementioned agreement;

[ ] subdivision D of Division 7 of Part 2-4 of the Fair Work Act 2009 as it applies under item 16 of Schedule 3 of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009 for approval for the termination of the abovementioned agreement after its nominal expiry date.

2. What is the industry of the employer?

[Specify industry.]

3. What is the name of the collective agreement-based transitional instrument to be terminated?

[Also include any ID/Code No. if known.]

4. What is the nominal expiry date of the agreement?

5. Please provide details of the employer covered by the agreement:

Name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

6. Please provide details of any employee organisations covered by the agreement:

Employee Organisation 1
Name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

7. If this application is made under subdivision C of Division 7 of Part 2-4 of the Act, please specify the date when the termination of this agreement was agreed to: (s.221)

8. If the date specified in question 7 is more than 14 days before this application for termination of the agreement was lodged, please provide details of the circumstances FWA should take into account in deciding if it is fair to extend the date for lodging this application:

Date:
Signature:
Name:
Capacity/Position:

Evidence requirements

If the application is made under s.222 of the Fair Work Act 2009 by virtue of the extended operation given by item 15 of Schedule 3 to the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009 (termination by agreement), this Application must be accompanied by a statutory declaration made by an appropriate person authorised by the Applicant (an officer or employee of the employer or employee organisation as the case may be) demonstrating how each of the requirements in s.223 are satisfied.

Service requirements

A copy of this application must be served on each employer and each employee organisation bound by the collective agreement-based transitional instrument as soon as practicable after the application is lodged.

Note: Rules 9 and 10 deal with service.

Form F29 Application for Approval of Termination of Individual Agreement-based Transitional Instrument

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR APPROVAL OF TERMINATION OF INDIVIDUAL AGREEMENT-BASED TRANSITIONAL INSTRUMENT

Fair Work (Transitional Provisions and Consequential Amendments)
Act 2009—items 17 and 19 of Schedule 3

(ITEAs, preserved individual State agreements, AWAs or Pre-reform AWAs)

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Name of other party to agreement

Name:
	ABN:
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Application is made for approval of the termination of an individual agreement-based transitional instrument under:

[ ] item 17, Schedule 3 to the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009;

[ ] item 19, Schedule 3 to the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009.

2. What is the industry of the employer?

[Specify industry.]

3. What is the identification number or date of the agreement to be terminated?

[Insert the ID number and/or date.]

4. What is the nominal expiry date of that agreement?

[Insert expiry date.]

5. If a termination agreement has been made, was the employee under the age of 18 years at the time that termination agreement was made?

[ ] Yes

[ ] No

Date:
Signature:
Name:
Capacity/Position:

Service requirements

The Applicant must serve a copy of this application on the other party to the individual agreement-based transitional instrument as soon as practicable after the application is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Other requirements

In relation to an application under item 17 of Schedule 3 of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009, a copy of a written agreement (termination agreement) in accordance with subitem 17(1) should accompany the application.

In relation to an application under item 19 of Schedule 3 of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009, the application must be accompanied by a statutory declaration made by a person authorised to do so indicating the facts establishing a basis for FWA to be satisfied that the requirements of subitems 19(2) and (3) have been complied with including a copy of the written declaration.

Multiple approvals via a single application form

An employer may use this form to make application for approval of the termination of multiple agreements, in which case the employer should attach a schedule setting out the relevant details and insert “see schedule” where appropriate on the form.

The schedule should be prepared using the standard form spreadsheet which can be found at: http://www.fwa.gov.au/documents/forms/form_f29.xls.

An electronic copy of the spreadsheet should be provided at the time the application is lodged. If the application is made under item 17 of Schedule 3 of the Fair Work (Transitional Provisions and Consequential Amendments) Act 2009, a copy of each of the relevant termination agreements must still accompany the application. The employer is not required to serve the schedule in a way that will reveal the identity of an employee on the schedule to other employees on the schedule.

Form F30 Application for a Majority Support Determination

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR A MAJORITY SUPPORT DETERMINATION

Fair Work Act 2009—s.236

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Employer(s) who will be covered by the proposed agreement)

Legal name:
Trading name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Employees who will be covered by the proposed enterprise agreement:

2.1 Will the proposed enterprise agreement cover all employees of the employer(s) listed above?

[ ] Yes

[ ] No

2.2 If “No”, specify the employees who will be covered by the proposed agreement (including by indicating how such employees are geographically, operationally and/or organisationally distinct):

3. Grounds:

[Using numbered paragraphs, set out the facts and circumstances on which the Applicant relies going to:

 the employer(s) listed above having not yet agreed to bargain, or initiated bargaining, for the proposed enterprise agreement;

 the group of employees who will be covered by the proposed agreement having been fairly chosen; and

 other matters, if any, that make it reasonable in all the circumstances to make the determination sought.]

4. Proposed method for determining majority support:

[Propose how FWA should be satisfied that a majority of the relevant employees want to bargain for an enterprise agreement.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the Respondent(s) and any other bargaining representatives listed in the application as soon as practicable after the document is lodged with FWA.

This application must also be served on other persons as directed by FWA if and when such direction(s) are given.

Note: Rules 9 and 10 deal with service.

Form F31 Application for a Scope Order

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR A SCOPE ORDER

Fair Work Act 2009—s.238

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Other bargaining representative(s))

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
A bargaining representative for:
Contact person: [If known]
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Grounds:

2.1 [Insert name of bargaining representative] is maintaining that the proposed agreement cover the following group of employees:

[Describe group]

2.2 The Applicant has concerns that bargaining for the proposed collective agreement is not proceeding efficiently or fairly because the agreement will not cover appropriate employees, or will cover employees that it is not appropriate for the agreement to cover.

3. Particulars:

[By reference to the operational, geographical and/or organisational location of the employees referred to in paragraph 2.1 and of other employees the Applicant contends should be covered by the agreement, identify how the agreement will not cover appropriate employees, or will cover employees that it is not appropriate for the agreement to cover.]

4. The Applicant contends that the proposed agreement should cover the following employees:

[Describe employees the Applicant contends should be covered by the proposed agreement.]

5. The Applicant has met, or is meeting, the good faith bargaining requirements?

[ ] Yes

[ ] No

6. Set out other circumstances, if any, relevant to whether it is reasonable to make the order sought:

7. Notice under s.238(3):

7.1 Attach a copy of any notice under s.238(3).

7.2 List the persons to whom that notice was given and the date such notice was given:

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the other bargaining representatives as soon as practicable after the document is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F32 Application for a Bargaining Order

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR A BARGAINING ORDER

Fair Work Act 2009—s.229

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Bargaining representative(s) against whom an order is sought)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
A bargaining representative for:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. What is the industry of the employer?

[Specify industry.]

2. Other bargaining representatives:

[List other bargaining representatives, if any, of whom the Applicant is aware and their addresses and contact details.]

3. Existing enterprise agreement(s):

[Identify all enterprise agreements that currently apply to an employee or employees who will be covered by the proposed agreement and the nominal expiry date of each such agreement: see s.229(3).]

4. Notice under s.229(4):

[If a notice under s.229(4) has been given, attach a copy of the notice and list the bargaining representatives to whom the notice was given and the date(s) on which it was given. If no such notice has been given, state that fact.]

5. Grounds:

[Using numbered paragraphs, set out the facts and circumstances upon which the Applicant relies in support of the application. Including:

 when the employer(s) agreed to bargain or initiated bargaining or whether a majority support determination, scope order or low-paid authorisation is in operation: see s.230(2);

 the facts and circumstances giving rise to a concern that one or more of the relevant bargaining representatives for the agreement have not met, or are not meeting, the good faith bargaining requirements or that the bargaining process is not proceeding efficiently or fairly because there are multiple bargaining representatives for the agreement (see s.230(3)), including any response to the concerns expressed in the notice under s.229(4).]

6. Order(s) sought:

[Set out the orders sought or attach a draft order. See s.231 for the content of bargaining orders.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the named Respondent(s) and other bargaining representatives as soon as practicable after it is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F33 Application for a Serious Breach Declaration

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR A SERIOUS BREACH DECLARATION

Fair Work Act 2009—s.234

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Bargaining representative(s) against whom an order is sought)

Name:
	ABN: [If known]
Address:
Suburb:		State:	Postcode:
A bargaining representative for:
Contact person:
Telephone:		Mobile:
Fax:		Email:

1. Other bargaining representatives:

[List other bargaining representatives, if any, of whom the Applicant is aware.]

2. What is the industry of the employer?

[Specify industry.]

3. Bargaining orders allegedly breached:

[List the bargaining order(s), the breach of which forms the basis of the application and attach a copy of each of those orders.]

4. Grounds:

[Using numbered paragraphs, set out the facts and circumstances upon which the Applicant relies in support of the application. Including the facts and circumstances upon which it is contended that the bargaining orders have been contravened in a serious and sustained way that has significantly undermined bargaining for the agreement and how the other requirements of s.235(2) are satisfied.]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served on the named Respondent(s) and other bargaining representatives as soon as practicable after it is lodged with FWA.

Note: Rules 9 and 10 deal with service.

Form F34 Application for a Protected Action Ballot Order

IN FAIR WORK AUSTRALIA	FWA use only
	FWA Matter No.:

APPLICATION FOR A PROTECTED ACTION BALLOT ORDER

Fair Work Act 2009—s.437

Applicant

Name:
	Title [if applicable] Mr [ ] Mrs [ ] Ms [ ] Other [ ] specify:
Address:
Suburb:		State:		Postcode:
A bargaining representative for:
If the Applicant is a company or organisation:
Contact person:			ABN:
Contact details for the Applicant or contact person (if one is specified):
Telephone:		Mobile:
Fax:		Email:

Applicant’s representative (if any)

Name:
	ABN: [If applicable]
Address:
Suburb:		State:	Postcode:
Contact person:
Telephone:		Mobile:
Fax:		Email:

Respondent(s) (Employer(s) who will be covered by the proposed agreement)

Name:
Address:
Suburb:	State:	Postcode:
Contact person:
Telephone:	Mobile:
Fax:	Email:

1. What is the industry of the employer?

[Specify industry.]

2. Existing enterprise agreement(s):

[Identify all enterprise agreements that currently apply to an employee or employees who will be covered by the proposed agreement and the nominal expiry date of each such agreement: see s.438.]

3. Group or groups of employees to be balloted:

[Set out details of the group or groups of employees to be balloted.]

4. Question(s) to be put:

[Set out the question(s) to be put to the employees who are to be balloted including the nature of the proposed industrial action.]

5. Proposed date by which voting is to close:

6. Protected action ballot agent:

6.1 Does the Applicant seek the appointment of someone other than the Australian Electoral Commission as the protected action ballot agent?

[ ] Yes

[ ] No

6.2 If “Yes”:

6.2.1 The Applicant seeks the appointment of the following person as the protected action ballot agent:

[Insert the name, address and contact details of the proposed protected action ballot agent. Note: If the proposed protected action ballot agent is the Applicant themselves, or an officer of the Applicant, FWA is required to appoint an independent ballot advisor and the name, address and contact details of any person proposed as an independent ballot advisor should also be included.]

6.2.2 What directions does the Applicant propose FWA should give to the protected action ballot agent pursuant to s.450?

[Set out proposed directions addressing each of the matters specified in s.450(2)(a)-(d) and s.450(4).]

Date:
Signature:
Name:
Capacity/Position:

Service requirements

This application must be served, within 24 hours after it is lodged with FWA, on:

 the employer(s) who will be covered by the proposed agreement;

 the proposed protected action ballot agent (in the case of the Australian Electoral Commission, by sending a copy of the application by email to secret.ballots@aec.gov.au) and any person proposed as an independent ballot advisor.

Note 1: Rules 9 and 10 deal with service.

Note 2: If the AEC is to be the ballot agent the copy of the application served on the AEC should be accompanied by a completed AEC information form (a copy of which can be found at www.aec.gov.au/elections/pab). There is no legal obligation to provide that form at the time of serving the application on the AEC but doing so will help the AEC to conduct the ballot in the shortest possible time.