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First Name *

Postal Address

Post Code


Last Name *

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Date of Birth *

Home Phone

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Name of Employer

Department / Location

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Hours worked in a week
N/A <20 20-30 >30 



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Work Phone

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Workplace Address

Number of Admin staff in your area

 
Do you identify as
N/A Aboriginal Torres Strait Islander


 

Authorised and published by Julie Bignell, Branch Secretary Australian Services Union Central and Southern Queensland Clerical and Administrative Branch, 29 Amelia Street, Fortitude Valley, Queensland, 4006