Schedule 2 Forms

Schedule 2 Forms

sections 9 and 10

Form 1 Notice to Industrial Registrar

Employment Protection Act 1982, sections 7 and 8

This Notice is given under the Employment Protection Act 1982, *section 7/*section 8.

[* Delete whichever is inapplicable]

Details of employer

Employer’s full name, address and telephone number—

[For sole employer or partnership give full names or for registered company give full registered title]

Business name, if any—

Nature of employer’s business or industry—

Are there particulars of the employer’s financial and other resources the employer desires the Commission to have regard to before making an order under the Act? Yes □ No □

Note—

If the answer is “yes”, under the Act, section 14(5), the Commission will take into account the financial or other resources of an employer that the employer discloses to it, either in this Notice or otherwise. Particulars may be disclosed by attaching the details as part of this Notice, see the Act, section 7(2A), or they may be disclosed to the Commission later, either in writing or in proceedings before the Commission. Where an employer claims that the details should be treated as confidential, the particulars should be disclosed later and, if in writing, forwarded to the Industrial Registrar in a sealed envelope marked “CONFIDENTIAL” with a covering letter, referring to this Notice, and setting out briefly why confidentiality is sought.

Is the employer a member of an industrial union of employers? Yes □ No □

If yes, name of union—

Details of employee

Employee’s full name, address and telephone number—

Date of birth of employee—

Employee is employed as— Adult □ Junior □ Apprentice □

Employee is employed— Full time □ Part time □ Casual □ Other □ [specify]

Is the employee a member of a relevant union? Yes □ No □ Not known □

If yes, name of union—

Employment details

Date on which employee last entered employment—

Date on or after which termination of employment effective—

Period of service, in years and months —

Work address—

Is the employee covered by a State Award/Former Industrial Agreement/Enterprise Agreement—
Yes □ No □

If covered by State Award/Former Industrial Agreement/Enterprise Agreement—