• Section A - Employer Details

  • Section B - Employee Details

  • Date Format: DD slash MM slash YYYY

  • Section C - additional requirements for 16 or 17 year olds

  • There have been changes to the eligibility requirements that could affect you if you were in this age group on 1 March 2020.  The effect of these changes means that eligibility is different for JobKeeper fortnights which begin before and on/after 11 May 2020. On or after 11 May 2020, there are additional requirements that must be met. For:

    • the first three JobKeeper fortnights (up to and including 10 May 2020) – complete Part A only
    • later JobKeeper fortnights (on/after 11 May 2020) – complete Part B only.

    Both Part A and B might be relevant to you, if so please complete both.

  • On 1 March 2020 were you at least 16 years of age?

  • If you answered YES, you satisfy this part of the eligibility requirement for the first three JobKeeper fortnights (up to and including 10 May 2020). You also need to satisfy additional eligibility requirements outlined in Section D below.

    If you answered NO, you are not eligible for JobKeeper payments. Go to Section D and select ‘No, I do not agree to be nominated by the employer outlined in Section A for the purpose of the JobKeeper scheme’ and return this form to your employer.

  • On 1 March 2020 were you at least 16 years of age and were you either:

    • ‘independent’ within the meaning of the Social Security Act 1991 or
    • not a ‘full time student’ within the meaning of the Social Security Act 1991?

  • If you answered YES, you satisfy this part of the eligibility requirement for JobKeeper fortnights on or after 11 May 2020. You also need to satisfy additional eligibility requirements outlined in Section D below.

    If you answered NO, you are not eligible for JobKeeper payments. Go to Section D and select ‘No, I do not agree to be nominated by the employer outlined in Section A for the purpose of the JobKeeper scheme’ and return this form to your employer.

    You are ‘independent’ (and will satisfy this part of the eligibility requirements) if you meet the definition in the Social Security Act 1991. Generally this will be the case if you:

    • have supported yourself through work with long term full or part-time employment broadly for a two year period
    • are, or have been, married or are in a registered relationship
    • live in a de facto relationship as a member of a couple for at least 12 months
    • have, or have had, a dependent child
    • are a job seeker assessed as unable to work over 30 hours a week
    • are unable to live at home due to extreme circumstances
    • have parents that are unable to support you
    • are a refugee and your parents do not live in Australia
    • are an orphan and have not been legally adopted
    • are in state care, including foster care

    Further guidance on this can be found on the Services Australia website at servicesaustralia.gov.au/individuals

    You are a ‘full time student’ (and not eligible for JobKeeper, unless you are also ‘independent’) if you were studying full time as defined in the Social Security Act 1991. Full-time study is defined in broad terms to mean enrolled in and undertaking study in a course of study at an educational institution of at least 75 per cent of the normal full-time study requirements.

    Further guidance on this can be found on the Services Australia website at servicesaustralia.gov.au/individuals

  • Section D - Nomination

  • To be an eligible employee, you need to meet these requirements:

    • You are currently employed by the employer outlined in Section A (including those stood down or re-hired).
    • You were employed by the employer outlined in Section A at 1 March 2020.
    • At 1 March 2020, you were a permanent or fixed term employee, or a casual employee employed on a regular and systematic basis during the period of 12 months ending on 1 March 2020.
    • If you are a casual employee as mentioned above, you are not employed by any other employer on a permanent or fixed term basis, or you are only employed by any other employer on a casual basis.
    • At 1 March 2020 you were either:
      • residing in Australia and an Australian citizen or permanent resident
      • an Australian resident for income tax purposes and a Subclass 444 (Special Category) visa holder.
    • You are not in receipt of a JobKeeper payment as a sole trader, nor is another employer, religious institution or eligible business in receipt of a JobKeeper payment for you.
    • You are not currently receiving parental leave pay or dad and partner pay.
    • You are not currently totally incapacitated for work and receiving payments under an Australian workers’ compensation law in respect of your total incapacity to work.
    • At 1 March 2020 you were either:
      • aged 18 years or over
      • aged 16 or 17 years and answered ‘Yes’ at Section C.

  • FOR EMPLOYEES AGED 16 AND 17 YEARS (only one of the following 3 boxes should be ticked)

  • In making this nomination I:
    1. (i) agree that I meet the eligibility requirements listed above, and
    2. (ii) confirm that I have not agreed to be nominated by any other employer, business or religious institution, and have not given another entity, or the Commissioner a nomination form for the purpose of this scheme.

  • FOR EMPLOYEES AGED 18 YEARS AND OVER

  • Section E - Declaration

  • I declare that the information I have provided is true and correct.

    Important: There are penalties for deliberately making a false or misleading statement.

  • Please type your full name
  • This field is for validation purposes and should be left unchanged.