Request Assistance Form

To request assistance in a workplace matter, please fill out the neccassary details below. It is important you give us as much information as possible about your request so we are able to  respond quickly and have all the information at hand to assist you. Requests on this page will be responded to within 24 hours.

Date

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Month JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember

Year 20082009201020112012201320142015201620172018

Are you a member?
  Yes

  No - Join Online today, click here.

First Name *	Last Name *
Membership Number	Date of Birth (DD/MM/YY) *

Where do you work? Address

Contact Details (h) Contact Details (W)

Can we contact you at work?   Yes  No

Manager's Name

How many clerical staff work here?
 

How many are members?

Do you know who your Delegate is?   Yes  No

Are you employed under:
  Letter of offer / appointment

  AWA

  Contract

  Other - Please Specify

Do you have a copy of it?
  Yes  No

My Problem / issue is: *

My Desired outcome is:

Office Use Only

Simple Query - Answered   Yes  No Referred to (Name) Completed Contact (Date) Contact Closed (Date) Industrial Officer