Form 18044-12 "Training and Skills Support/Job Search Support - Application Form" - Queensland, Australia

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Download Form 18044-12 "Training and Skills Support/Job Search Support - Application Form" - Queensland, Australia

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Training and Skills Support/Job Search Support - Application form
Please note: Receipt of this subsidy/assistance may affect Commonwealth Support Payments
(either in full or in part). It is the applicant’s responsibility to make enquires with Centrelink on the
impact of payments under the Workers Assistance Scheme prior to applying for assistance
Eligibility requirements
Proof of employee or employees partner identity (acceptable forms of ID are drivers licence or birth certificate as well as
Medicare card)
Proof of course details or support, including, dates, costs and provider
Proof of ordinary time earnings (payslips) and Sibelco leave approval, if claiming compensation for unpaid leave to
undertake approved training prior to retrenchment
Training must meet the below definition of approved training:
Training that provides links to career options for affected workers. This training should align with the eligible worker’s
individual employment goals, as discussed and approved with the Employment Services Manager (ESM).
Job Search Support is immediate, direct and tailored services to support affected workers find alternative employment. Support
can include: career counselling, job referral, resume writing, interview skills and literacy and numeracy support.
Applicant information
Sibelco employee
Office use only - ESM to complete
number:
Case number:
Title:
Surname:
Given name(s):
Date of birth:
Home address:
Home phone:
Mobile:
Email:
1
Training and Skills Support
Qualification :
Cost:
Course title:
End date:
Start date:
Provider name:
Provider address:
Provider email:
Provider phone:
Office use only - ESM eligibility assessment
Yes
No
North Stradbroke Island – Workers Assistance Scheme
Training and skills support and job search support – Application form
18044-12 02-20
Page 1 of 3
Training and Skills Support/Job Search Support - Application form
Please note: Receipt of this subsidy/assistance may affect Commonwealth Support Payments
(either in full or in part). It is the applicant’s responsibility to make enquires with Centrelink on the
impact of payments under the Workers Assistance Scheme prior to applying for assistance
Eligibility requirements
Proof of employee or employees partner identity (acceptable forms of ID are drivers licence or birth certificate as well as
Medicare card)
Proof of course details or support, including, dates, costs and provider
Proof of ordinary time earnings (payslips) and Sibelco leave approval, if claiming compensation for unpaid leave to
undertake approved training prior to retrenchment
Training must meet the below definition of approved training:
Training that provides links to career options for affected workers. This training should align with the eligible worker’s
individual employment goals, as discussed and approved with the Employment Services Manager (ESM).
Job Search Support is immediate, direct and tailored services to support affected workers find alternative employment. Support
can include: career counselling, job referral, resume writing, interview skills and literacy and numeracy support.
Applicant information
Sibelco employee
Office use only - ESM to complete
number:
Case number:
Title:
Surname:
Given name(s):
Date of birth:
Home address:
Home phone:
Mobile:
Email:
1
Training and Skills Support
Qualification :
Cost:
Course title:
End date:
Start date:
Provider name:
Provider address:
Provider email:
Provider phone:
Office use only - ESM eligibility assessment
Yes
No
North Stradbroke Island – Workers Assistance Scheme
Training and skills support and job search support – Application form
18044-12 02-20
Page 1 of 3
Compensation for unpaid leave to undertake approved training prior to retrenchment
Compensation is available for unpaid leave to attend approved training. A maximum of four weeks ordinary time earnings per worker
may be claimed.
Yes
No
Are you claiming compensation for required leave without pay to undertake
training prior to being made redundant by Sibelco?
Yes
No
Has unpaid leave to undertake training been approved by Sibelco?
Yes
No
Has a Training and Skills Support or Job Search Support application for this
training been approved? Please provide details below
Office use only - ESM eligibility assessment
Yes
No
Leave dates:
Hours of leave:
Ordinary hours worked per week:
Hourly rate:
Compensation amount: $
Applicant or provider payment details
Account name:
Account number:
BSB:
2. Job Search Support
Job search support Information:
Type of support (i.e. resume
assistance, career counselling, course):
Provider:
Provider address:
email:
Provid er phone:
Provid er
Date (if applicable):
Cost: $
Office use only - ESM eligibility assessment
Yes
No
Applicant or provider payment details
Account name:
BSB:
Account number:
North Stradbroke Island – Workers Assistance Scheme
Training and skills support and job search support – Application form
18044-12 02-20
Page 2 of 3
Applicant declaration
Privacy Statement: The Department of Employment, Small Business and Training collects your personal information in
order to provide assistance under the North Stradbroke Island Workers Assistance Scheme (WAS) for the purpose of
administering the WAS. Your information may also be provided to other Queensland agencies, agencies of other States,
Australian Government agencies, local government and non-government organisations including business entities, for the
purpose of administering, monitoring, auditing, evaluating and promoting the WAS. Your personal information will be
managed in accordance with the Information Privacy Act 2009.
I,
(applicant’s full name) hereby declare
that the information I have provided is true and correct and that I have not previously applied for or received the same
assistance measure under the WAS. I understand giving false or misleading information to obtain a benefit from the
Queensland Government is fraudulent and may contravene section 408C of the Queensland Criminal Code.
I understand that the receipt of this subsidy/assistance may affect Commonwealth Support Payments (either in full or in
part) and it is my responsibility to make enquires with Centrelink on the impacts of payments under the WAS prior to
applying for assistance.
I understand that payments will be made within 14 days of the submission of application form and supporting
documentation by the Employment Services Manager.
I agree to repay any subsidy/assistance or overpayment made as a result of my providing incorrect information or being
found to be ineligible and the Queensland Government may refer cases of suspected fraud to the Queensland Police
Service for investigation.
Applicant Name
Applicant Signature
Date
Employment Services manager (ESM)
ESM Signature
Date
OFFICE USE ONLY: ESM Checklist - Confirm each item if applicable
N/A
Yes
No
Proof of payment, if course or support undertaken and payment is in arrears
Case number assigned
Copy of drivers licence or birth certificate attached
Copy of medicare card attached
Is the applicant a partner of an affected worker?
Does training or support meet the approved definition?
Copy of invoice from provider attached
Has the employee been made redundant by Sibelco?
Is compensation for leave without pay to undertake training being claimed?
Copy of payslip attached
Copy of Sibelco approval attached
NOTES (office use only)
North Stradbroke Island – Workers Assistance Scheme
Training and skills support and job search support – Application form
18044-12 02-20
Page 3 of 3
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