JobKeeper Permanet Employee Nomination Notice WA

Section A - Employer Details

Employer Name*

Employer Australian business number (ABN)*

Name*

Salutation First Name Middle Name Last Name

Employee ID Number*

Date of Birth*

Address*

Phone*

Email*

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.
As at 1 March 2020, you were a permanent employee, or a casual employee employed on a regular or 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 permanently employed by any other employer, or you are only employed by any other employer on a casual basis.
You were at least 16 years of age as at 1 March 2020.
If you were 17 years of age or below as at 1 March 2020, you will only be eligible for JobKeeper if you are considered to be financially independent.
As at 1 March 2020 you were:

residing in Australia and an Australian citizen or permanent resident, or
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 or eligible business in receipt of a JobKeeper payment for you.

You are not currently receiving parental leave pay or dad and partner pay, and
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.

Please nominate your preference*

YES, I agree to be nominated by the employer outlined in section A for the purpose of the JobKeeper scheme.
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/entity and have not given another entity a nomination form for the purpose of this scheme.
OR
NO, I do not agree to be nominated by the employer outlined in section A for the purpose of the JobKeeper scheme.

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

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

Signature

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Digital Signature

Email

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