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AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION RULES 1998 No. 1 - SCHEDULE
SCHEDULE
FORM R1 Rule 11
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF APPEAL UNDER REGON 45 IN the matter of:
[title of matter and case number] Notice of an appeal is given by [name of
applicant] against [* the decision, award, order or opinion made or act or
refusal or failure to make a decision or do an act] by [name of member of the
Commission] at [place] on [date] in this matter. The grounds of this appeal
are as follows:
[Set out in numbered paragraphs the grounds including particulars of the
grounds on which it is claimed that the matter is of such importance that, in
the public interest, leave to appeal should be granted.]
Dated 19 .
[Signature of appellant]
*The appellant must detail the particulars of the matter(s) being appealed by
way of specific reference to the categories listed in subsection 45 (1) of the
Act. Note: If it is intended to seek a stay of the whole or part of the award,
order or decision pending the determination of the appeal, the notice of
appeal must include an application to that effect, as set out below:
"Application is also made for an order that the operation of [Set out the
whole or part of the award, order or decision] be stayed pending the
determination of this appeal or until further order of the Commission."
Dated 19 .
[Signature of applicant]
FORM R2 Rule 11
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION APPLICATION FOR AN EXTENSION OF
TIME FOR INSTITUTING AN APPEAL IN the matter of:
[title of matter and case number] Application is made by [name of applicant]
for an extension of time for instituting an appeal against [* the decision,
award, order or opinion made or act or refusal or failure to make a decision
or do an act] by [name of member of Commission] at [place] on [date] in this
matter. The grounds of this application are as follows:
[Set out in numbered paragraphs the grounds on which it is claimed an
extension of time should be granted.]
Dated 19 .
[Signature of applicant]
* The applicant must detail the particulars of the matter(s) being appealed by
way of specific reference to the categories listed in subsection 45 (1) of the
Act.
FORM R3 Rule 13
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF APPEAL UNDER REGON 81 IN the matter of:
[title of matter] Notice of an appeal is given by [name of appellant] against
[* the decision made or act or refusal or failure to make a decision or do an
act] by [name of Registrar] at [place] on [date] in this matter. The grounds
of this appeal are as follows:
[Set out in numbered paragraphs the grounds including particulars of each
ground.]
Dated 19 .
[Signature of appellant]
* The appellant must detail the particulars of the matter(s) being appealed.
Note: If it is intended to seek a stay of the whole or part of the decision or
act concerned pending the determination of the appeal, the notice of appeal
must include an application to that effect, as set out below:
"Application is also made for an order that the operation of [Set out the
whole or any part of the decision or act concerned] be stayed pending the
determination of this appeal or until further order of the Commission."
Dated 19 .
[Signature of appellant]
FORM R4 Rules 14 and 15
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTIFICATION OF AN ALLEGED INDUSTRIAL DISPUTE Under section 99 of the
Workplace Relations Act 1996, [name of organisation or employer or Minister]
notifies you of the existence of an alleged industrial dispute between:
[names and addresses of all parties to the industrial dispute] concerning
[*matters in dispute including any claims] Awards binding on the parties to
the dispute are [Insert the titles of the awards] State whether industrial
action has been taken, is being taken or is threatened.
** The Commission is asked to deal with this matter on the basis of an earlier
finding of dispute in matter C No .
Dated 19 .
[Signature of notifier]
* The original and 2 copies of the notification of an alleged industrial
dispute arising from the service of a log of claims should be accompanied by 2
copies of:
- the letter of demand;
- the log of claims;
- the list of persons served in accordance with the Rules of the Commission;
- a statement as to service by a person having knowledge of the facts; and
- a statement by an officer having knowledge of the facts and authorised for
the purpose by the committee of management of the organisation serving the log
of claims, that the letter of demand and log were served with the authority of
the organisation.
** Omit if inapplicable.
FORM R5 Rule 16
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
INFORMATION SHEET This information sheet is, under the rules of the Australian
Industrial Relations Commission (the Commission), provided for the information
of employers served with demands by unions. It is not intended to be
comprehensive. The matters referred to in this information sheet are governed
by the Commonwealth Workplace Relations Act 1996 and the regulations and
rules made under it. Employers seeking further information or wanting advice
should consult their industrial relations, legal or other advisers. Union
demands on employers are frequently made by a letter demanding agreement,
within a specified time, to matters set out in a log of claims. If the demands
are not agreed to, the union will normally notify the Commission that an
alleged industrial dispute exists between it and the employers. The
Commission, on being notified, will list the alleged industrial dispute for
hearing. Employers served with the demand will be advised of the time and
place of hearing. At the hearing the Commission will normally decide whether
there is an industrial dispute and if so, who the parties to it are and what
the matters in dispute are. You are not obliged to be represented at the
hearing. However, if you are not represented, the hearing will normally go
ahead in your absence and determinations may be made contrary to your
interests. Whether you should be represented at the hearing is a matter about
which you may wish to consult your advisers. If the Commission finds that an
industrial dispute exists between a union and employers, the union may seek
the making of an agreement or an award in settlement (or part settlement) of
the dispute. Under the Workplace Relations Act an award may bind, among
others, employers who do not satisfy the Commission that they are not parties
to the industrial dispute (s 149 (1) (c)).
FORM R6 Rule 22
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION TO SET ASIDE OR VARY AN AWARD IN the matter of:
[title of award] Application is made by [name of the organisation or person]
*for the setting aside/*variation of the abovementioned award in the following
terms. [Set out terms of variation] The grounds on which this application is
made are as follows:
[Set out in numbered paragraphs the grounds]
Dated 19 .
[Signature of applicant]
* Omit whichever is inapplicable. To the persons and organisations bound by
the abovementioned award. You are hereby notified that the abovementioned
application will be heard by [name of Commission member] at [time] on [date]
at [place] and that you may appear and be heard at the time and place so
fixed.
Dated 19 .
[Signature]
Member of Commission
[or Registrar]
FORM R7 Rule 23
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR VARIATION OF AWARD TO GIVE EFFECT TO AGREEMENT
NEGOTIATED UNDER ENTERPRISE FLEXIBILITY PROVISION IN the matter of:
[title of award and original dispute number] Application is made by [name of
applicant] to vary the abovementioned award for the purpose of giving effect
to the attached agreement negotiated under the enterprise flexibility
provision of the above award.
Dated 19 .
[Signature of applicant] Note: In respect of each party to the agreement, the
application must be accompanied by statutory declarations of the type
described in subrule 23 (2).
FORM R8 Rule 24
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR AN ORDER UNDER REGON 118A IN RELATION TO
REPRESENTATION RIGHTS OF ORGANISATIONS OF EMPLOYEES Application is made by
[name of applicant] for the following order:
[Set out terms of order sought including detail of the demarcation dispute in
relation to which the jurisdiction to make an order is to be exercised] The
grounds on which this application is made are as follows:
[Set out the grounds in numbered paragraphs] The following organisations and
persons may have an interest in this matter:
[Set out names of organisations and persons which may have an interest in this
matter]
Dated 19 .
[Signature of applicant]
FORM R9 Rule 25
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR AN ORDER TO STOP OR PREVENT INDUSTRIAL ACTION IN the matter
of:
* an industrial dispute between [names of parties to the industrial dispute
directly affected or likely to be directly affected by the industrial action
and case number]
* a negotiation or proposed negotiation of an agreement under Division 2 of
Part VIB between [names of all negotiating parties and bargaining case number]
* work that is regulated by [title of the award or certified agreement]
Application is made by [name of applicant] for an order under subsection 127
(2) of the Act in the following terms: [Set out terms of order] The grounds on
which this application is made are as follows: [Set out the grounds in
numbered paragraphs, including details of: . the industrial action which is
happening, or is threatened, impending or probable; and . where the applicant
is a person directly affected, or likely to be directly affected, by the
industrial action (other than a party to the industrial dispute (if any))Ñhow
the applicant is so affected or likely to be affected; and . where the
industrial action relates to work regulated by an award or certified
agreementÑthe title of the award or certified agreement and the organisations
and persons bound by the award or agreement who are directly affected or
likely to be directly affected by the industrial action .]
Dated 19 .
[Signature of applicant] To:
*parties to the abovementioned industrial dispute
*negotiating parties to the abovementioned negotiation or proposed negotiation
*organisations and persons bound by the abovementioned award or agreement who
are directly affected or likely to be directly affected by the industrial
action You are hereby notified that the abovementioned application will be
heard by the Commission at [time] on [date], at [place], and that you may
appear and be heard at the time and place so fixed.
Dated 19 .
[Signature]
Member of Commission
[or Registrar]
* Omit whichever is inapplicable.
FORM R10 Rule 28
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTIFICATION OF BOYCOTT DISPUTE TO:
[name of Registrar or President of the Commission] Under section 157 of the
Act [name of party notifying dispute] notifies you of the existence of a
boycott dispute between:
[names and addresses of all parties to the alleged dispute] concerning:
[Set out details of the boycott or threatened, impending or probable boycott ]
The alleged dispute relates to a boycott, or a threatened, impending or
probable boycott, in relation to which there are proceedings pending before
the Court and in which the Australian Competition and Consumer Commission is a
party to the proceedings.* The following persons are, to the best of my
knowledge and belief, persons who are entitled under section 160 of the Act to
be a party to the proceeding before the Commission:
[Set out names and addresses of the persons] Cite the award(s) or certified
agreement relevant to the dispute (if applicable).
Dated 19 .
[Signature of notifier]
* Omit if inapplicable.
FORM R11 Rule 29
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
WRITTEN NOTICE OF INTENTION TO BRING ACTION IN TORT TO:
[name of Registrar or member of Commission] Under section 166A of the Act
[name of party giving notice] gives you notice of its intention to bring an
action in tort against [Insert names of organisation(s) and/or the names of
officer(s), member(s), or employee(s) of [name of organisation(s)]] and other
persons* in respect of conduct by [Insert details of conduct to be subject of
action, including names and addresses of all alleged parties to the dispute or
disputes to which the conduct relates]. The award(s) or certified agreement(s)
relevant to the dispute (if applicable) are:
Dated 19 .
[Signature of notifier]
* Omit if inapplicable.
FORM R12 Rule 31
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR CANCELLATION OR SUSPENSION OF AN AWARD IN the matter of:
[title of award ] Application is made by [name of applicant] for the
abovementioned award (or the following terms of the abovementioned award) to
be cancelled or suspended.
[Set out, if necessary, the terms sought to be cancelled or suspended] The
grounds on which this application is made are as follows:
[Set out in numbered paragraphs the grounds]
Dated 19 .
[Signature of applicant] To the applicant and to the other parties to the
award: You are notified that the abovementioned application will be heard by
the Commission at [time] on [date], at [place], and that you may appear and be
heard at the time and place so fixed.
Dated 19 .
[Signature]
Member of Commission
[or Registrar]
FORM R13 Rule 33
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR ORDER REQUIRING EQUAL REMUNERATION FOR WORK
OF EQUAL VALUE Application is made by [name of the employee or trade union
whose rules entitle it to represent the industrial interests of employees to
be covered by the order (or the Sex Discrimination Commissioner)] for the
making of an order for employee(s) covered by the order that there will be
equal remuneration for work of equal value. The order sought is:
[Set out the terms of the proposed order including the employee(s) to be
covered by the order] The grounds on which this application is made are as
follows:
[Set out in numbered paragraphs the grounds including particulars of the
grounds on which it is claimed that no adequate alternative remedy exists
under section 170BE of the Act] No proceedings for an alternative remedy have
begun under another provision of the Act or under another law of the
Commonwealth or under a law of a State or Territory/Proceedings or the
proceedings for an alternative remedy have been discontinued or failed for
want of jurisdiction.* The applicant seeks that the power of the Commission
under section 170BI of the Act to prevent an industrial dispute about equal
remuneration for work of equal value for employees be exercised.* The
following trade unions and employer organisations or associations may, to the
best of the knowledge and belief of the applicant, have an interest in the
matter:
[Set out trade unions and employer organisations or associations which may
have an interest in the matter] The following employer(s) may, to the best of
the knowledge and belief of the applicant, have an interest in the matter:
[Set out employer(s) who may have an interest in the matter] The following
organisations and persons are likely to be a party/parties to the dispute to
be prevented:*
[Set out organisations and persons likely to be a party/parties to the
dispute]
Dated 19 .
[Signature of applicant]
* Omit if inapplicable.
FORM R14 Rule 33
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF HEARING FOR APPLICATION FOR ORDER FOR EQUAL
REMUNERATION FOR WORK OF EQUAL VALUE IN the matter of:
[case number] Notice is givenÐ
(a) that on [date] the Commission received an application for an order for
equal remuneration for work of equal value in respect of the
undermentioned employee(s):
[Set out employee(s) to be covered];
(b) that the matter will be heard at [time] on [date] at [place] before
[name of Commission Member]; and
(c) that each trade union whose rules entitle it to represent the
industrial interests of any of the employees concerned and each
organisation or association representing employers of any of those
employees and wishing to be heard in relation to the application is
invited to attend the Commission on the abovementioned date; and
(d) that any employer of employees to be covered by the order and wishing
to be heard in relation to the application is invited to attend the
Commission on the abovementioned date. A copy of the application may
be inspected at the Australian Industrial Registry at [address] free
of charge.
[Signature]
Registrar
FORM R15 Rule 34
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR EMPLOYMENT TERMINATION ORDER BY COMMISSION
CREATING RULES OF GENERAL APPLICATION Application is made by [name of employee
or of trade union whose rules entitle it to represent the industrial interests
of employee(s) to be covered by the order] for the making of an order giving
effect to
* Article 12 of the Termination of Employment Convention in so far as it
relates to a severance allowance or separation benefits in relation to the
termination of employment of employees
* Article 13 of the Termination of Employment Convention in relation to the
termination of employment of employees in respect of the undermentioned
employee(s). The order sought is:
[Set out terms of the order sought including the employee(s) to be covered by
the order] The grounds on which this application is made are as follows:
[Set out in numbered paragraphs the grounds including particulars of the
grounds on which it is claimed that no alternative mechanism exists under
section 170FC of the Act] The following trade unions and employer
organisations or associations may, to the best of the knowledge and belief of
the applicant, have an interest in the matter:
[Set out trade unions and employer organisations or associations which may
have an interest in the matter] The following employer(s) may, to the best of
the knowledge and belief of the applicant, have an interest in the matter:
[Set out employer(s) who may have an interest in the matter]
Dated 19 .
[Signature of applicant]
* Omit if inapplicable.
FORM R16 Rule 34
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF HEARING FOR APPLICATION FOR EMPLOYMENT TERMINATION
ORDER CREATING RULES OF GENERAL APPLICATION IN the matter of:
[case number] Notice is givenÐ
(a) that on [date] the Commission received an application for an
employment termination order giving effect to
* Article 12 of the Termination of Employment Convention in so far as it
relates to a severance allowance or separation benefits in relation to the
termination of employment of employees
* Article 13 of the Termination of Employment Convention in relation to the
termination of employment of employees in respect of the undermentioned
employee(s):
[Set out employee(s) to be covered by the order]; and
(b) that the matter will be heard at [time] on [date] at [place] before
[name of Commission Member]; and
(c) that each trade union whose rules entitle it to represent the
industrial interests of any of the employees concerned and each
organisation or association representing employers of any of those
employees and wishing to be heard in relation to the application is
invited to attend the Commission on the abovementioned date; and
(d) that any employer of employees to be covered by the order and wishing
to be heard in relation to the application is invited to attend the
Commission on the abovementioned date. A copy of the application may
be inspected at the Australian Industrial Registry at [address] free
of charge.
Dated 19 .
[Signature]
Registrar
* Omit if inapplicable.
FORM R17 Rule 35
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR ORDER IF EMPLOYER FAILS TO CONSULT TRADE UNION
ABOUT TERMINATIONS Application is made by [name of the employee, or trade
union whose position is to be affected by the order or trade union whose rules
entitle it to represent the industrial interests of such employees] for the
making of an order where the employer fails to consult [name of trade union]
about terminations. The order sought is:
[Set out terms of the order sought and name and address of employer] The
grounds on which this application is made are as follows:
[Set out in numbered paragraphs the grounds including the particulars of the
grounds on which it is claimed that no alternative remedy exists under section
170GC of the Act]
Dated 19 .
[Signature of applicant]
FORM R18 Rule 37
Australian Industrial Relations Commission Commission use only
Application for relief in respect of file
termination of employment number
Workplace Relations Act 1996 (Cth) date received
Subsection 170CE (1) In making this claim you (the applicant) should be aware
that: . specified categories of employees are excluded from making a claim
under the Termination of Employment provisions of the Workplace Relations Act
1996 . . an application lodged more than 21 days after the day on which the
termination took effect can only be accepted if the Commission decides it
would be unfair not to do so . section 170CJ of the
Workplace Relations Act 1996 allows, in certain circumstances, the Commission
to make an order for costs . Regulation 30BD requires a fee of $50 to be paid
on lodgment of this application in the Commission unless a Registrar has
approved the waiving of the fee. The $50 lodgment fee is refundable under
certain circumstances Details in relation to these matters are available from
the Industrial Registry. Details of Employee (the applicant)
Mr Mrs Ms Family name given names
1 full name 2 home address
postcode
3 phone (business hours) ( )
(after hours) ( )
facsimile ( )
4 date of birth day/month/year
5 first language English other (specify)
Is an interpreter needed? Yes No
Is there a family member or friend who can
assist you? Yes No
Details of employer 6 employer's name
contact person 7 employer's trading address or registered office
postcode
phone ( ) fax ( )
8 work performed for employer (occupation)
9 place of work suburb/town postcode
10 date first worked / /
11 last date worked / /
12 date termination / / [State the date when you think
of employment took the termination of employment took effect
effect if the date is different to the date last
worked] Did you receive written notice of termination/ separation
certificate? No Yes I attach a copy
13 Other employment State the name of the award or agreement
details (if known) (including Australian Workplace Agreement)
under which you were employed immediately prior
to the termination
State whether the award or agreement is State
or Federal
Federal State If State, name of State
Extension of Time 14 This section to be completed if the application is lodged
more than 21 days after the day on which the termination took effect. (see
Item 12 above). In such cases, the Commission must decide whether to accept
the application. My reason/s for seeking an extension of time to lodge this
application is/are: (or attached) Details of your representative or union
15 Is anyone representing you? No go to 19 Yes go to 16
16 name of legal firm, union or other representative 17 contact name at legal
firm, union or other representative 18 address of legal firm, union or other
representative
postcode
phone ( ) fax ( )
Notices from the Commission
19 Where do you want address in 2 solicitor or union other
notices from the in 18 give details
Commission sent? (choose one only)
Grounds for application
20 Grounds upon Identify the ground or grounds under subsection
which this 170CE (1) of the Workplace Relations Act 1996
application upon which this application is basedÑ
is based (a) on the ground that the termination was harsh,
unjust or unreasonable; and/ or
(b) on the ground of an alleged contravention ofÑ
section 170CK (discrimination or other prohibited
reasons); and/ or
section 170CL (failure to notify the CES of
redundancies); and/ or
section 170CM (failure to give statutory notice);
and/ or
section 170CN (failure to comply with a section
170FA order) Relief Sought
21 What are reinstatement an amount in respect of otherÑgive
you seeking? the remuneration lost, details
or likely to have been
lost, by you, because of
the termination 22 Brief summary of reasons given for termination
(or attached) Declaration I declare that no proceedings in respect of the
termination that is the subject of this claim have been commenced (other than
proceedings that have since been discontinued or failed for want of
jurisdiction) by me or on my behalf under any other provision of the
Workplace Relations Act 1996 or under any other law of the Commonwealth or of
a State or Territory. I further declare that all the facts in this application
are correct and complete to the best of my knowledge and belief.
The employee must sign (signature of employee)
this declaration unless a solicitor, union or other representative has
prepared the application.
(date) / /
signature of solicitor, union or other
representative
(date) / /
see next page for lodgment fee details
U No _____________________________ FEE [Regulation 30BD requires a fee of
$50.00 to be paid on lodgment of this application in the Commission unless a
Registrar has approved the waiving of the fee (in which case a copy of the
Registrar's approval should accompany this application). If an application is
lodged by facsimile transmission the credit card details must be provided]
cash
cheque/money order (to be made payable to "Collector of Public Monies,
Australian Industrial Registry")
Bankcard Visa Mastercard
Card Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Card Expiry Date ____ / ____
Cardholder's Name__________________________________________ Normal Card
Signature _____________________________________ In the event of a refund of
the lodging fee being applicable, the refund should be forwarded to: For all
enquiries in .............................. please contact the
............................... Registry
......................................................................
................................ Phone: (...) ..................... Fax: (...)
............................. [NoteÑA copy of this completed form (and any
attachments) will be forwarded to your former employer]
FORM R19 Rule 37
Australian Industrial Relations Commission Commission use only
Application for relief in respect of file
termination of employment number
Workplace Relations Act 1996 (Cth) date received
Subsection 170CE (2) or (4) This Form is to be completed in respect of an
application to the Commission for relief in respect of termination of
employment solely on the ground of an alleged contravention of section 170CL
of the Workplace Relations Act 1996. Section 170CL states:
"(1) This section applies if an employer decides to terminate the employment
of 15 or more employees for reasons of an economic, technological, structural
or similar nature, or for reasons including such reasons.
(2) As soon as practicable after so deciding and before terminating an
employee's employment because of the decision, the employer must give to the
Commonwealth Employment Service a written notice of the intended terminations
that set out:
(a) the reasons for the terminations; and
(b) the number and categories of employees likely to be affected; and
(c) the time when, or the period over which, the employer intends to carry
out the terminations.
(3) The employer must not terminate an employee's employment pursuant to the
decision unless the employer has complied with subsection (2).". In making
this claim you (the applicant) should be aware that: . specified categories of
employees are excluded from making a claim under the Termination of Employment
provisions of the Workplace Relations Act 1996 . . an application lodged more
than 21 days after the day on which the employee is given notice of the
decision to terminate the employee's employment can only be accepted if the
Commission decides it would be unfair not to do so. . section 170CJ of the
Workplace Relations Act 1996 allows, in certain circumstances, the Commission
to make an order for costs . Regulation 30BD requires a fee of $50 to be paid
on lodgment of this application in the Commission unless a Registrar has
approved the waiving of the fee. The $50 lodgment fee is refundable under
certain circumstances Details in relation to these matters are available from
the Industrial Registry. Details of employer alleged to have contravened
section 170CL 1 employer’s name
contact person 2 employer's trading address or registered office
postcode
phone ( ) fax ( )
3 date notice of decision to
terminate employee's / /
employment was given.
4 other employment details State the name of the award or agreement
(including Australian Workplace
Agreement) under which the employees
are*/ were employed
State whether the award or agreement is
State or Federal
Federal
State If State, name of State 5 About the employees Here insert name and
address of employee/s whose employment has been* / is proposed to be *
terminated by the employer 6 Brief summary of reasons given for termination or
threatened termination
(or attached) Extension of Time 7 This section to be completed if the
application is lodged more than 21 days after the day on which the employee is
given notice of the decision to terminate the employee's employment (see Item
3 above). In such cases, the Commission must decide whether to accept the
application. My reason/s for seeking an extension of time to lodge this
application is/are:(or attached) Details of Union
8 Is your union acting No go to 11
on your behalf Yes go to 9
9 name and address of union Postcode
10 union contact person
phone ( ) fax ( )
Details of representative
11 Is anyone representing No go to 15 Yes go to 12
you? 12 name of solicitor or representative's firm 13 name of contact person
14 address
Postcode
phone ( ) fax ( )
Notices from the Commission
15 Where do you want address in 5 union in 9 other in 12
notices from the give details
Commission sent? (choose one only) Declaration I declare that no proceedings
in respect of the termination that is the subject of this claim have been
commenced (other than proceedings that have since been discontinued or failed
for want of jurisdiction) in respect of or on behalf of the employee under any
other provision of the Workplace Relations Act 1996 or under any other law of
the Commonwealth or of a State or Territory. I further declare that all the
facts in this application are correct and complete to the best of my knowledge
and belief.
The employee must sign Signature of employee
this declaration* date / /
If a solicitor or authorised Signature of solicitor
representative has prepared the or representative
application, that person must
sign here date / /
If a union or an inspector is Signature for union or inspector
applying on behalf of the date / /
employee, a union representative Name (print)
or the inspector, as the case position
may be, must sign here
U No _____________________________ FEE [Regulation 30BD requires a fee of
$50.00 to be paid on lodgment of this application in the Commission unless a
Registrar has approved the waiving of the fee (in which case a copy of the
Registrar's approval should accompany this application). If an application is
lodged by facsimile transmission the credit card details must be provided]
cash
cheque/money order (to be made payable to "Collector of Public Monies,
Australian Industrial Registry")
Bankcard Visa Mastercard
Card Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Card Expiry Date ____ / ____
Cardholder's Name __________________________________________ Normal Card
Signature ______________________________________ In the event of a refund of
the lodging fee being applicable, the refund should be forwarded to:
Commission Use Only Receipt Number__________________________/Credit
Transaction Processed___________________
FORM R20 Rule 37
Australian Industrial Relations Commission Commission use only
Application for relief in respect of file number
termination of employment
Workplace Relations Act 1996 (Cth) date received
Subsection 170CE (3) This Form is to be completed in respect of an application
to the Commission for relief in respect of termination of employment solely on
the ground or grounds of an alleged contravention of one or more of sections
170CK, 170CM and 170CN of the Workplace Relations Act 1996. In making this
claim the applicant union (being a trade union whose rules entitle it to
represent the industrial interests of the employee) should be aware that: .
specified categories of employees are excluded from making a claim under the
Termination of Employment provisions of the Workplace Relations Act 1996 . .
section 170CJ of the Workplace Relations Act 1996 allows, in certain
circumstances, the Commission to make an order for costs . Regulation 30BD
requires a fee of $50 to be paid on lodgment of this application in the
Commission unless a Registrar has approved the waiving of the fee. The $50
lodgment fee is refundable under certain circumstances Details in relation to
these matters are available from the Industrial Registry. Application is made
byÑ Name of union making application address of union
postcode
phone ( ) fax ( )
union contact person for notices from the Commission The application is made
on behalf of the following employee/s Name/s of employee/s (or attached)
Grounds for application Identify the ground or grounds under subsection 170CE
(3) of the Workplace Relations Act 1996 upon which this application is basedÑ
on the ground or grounds of an alleged contravention of one or more ofÑ
section 170CK ; and/ or
section 170CM ; and/ or
section 170CN Details of employer employer's name contact person employer's
trading address or registered office
postcode
phone ( ) fax ( )
date/s of termination of
employee/s employment / /
other employment details State the name of the award or agreement
(including Australian Workplace Agreement)
under which the employee/s were employed
immediately prior to the termination/s
State whether the award or agreement is
State or Federal
Federal State If State, name of State
Relief Sought
Identify the type of reinstatement compensation otherÑgive
relief being sought details
Declaration I declare that all the facts in this application are correct and
complete to the best of my knowledge and belief. union representative must
sign here
date / /
name (print)
position
U No _____________________________ FEE [Regulation 30BD requires a fee of
$50.00 to be paid on lodgment of this application in the Commission unless a
Registrar has approved the waiving of the fee (in which case a copy of the
Registrar's approval should accompany this application). If an application is
lodged by facsimile transmission the credit card details must be provided]
cash
cheque/money order (to be made payable to 'Collector of Public Monies,
Australian Industrial Registry')
Bankcard Visa Mastercard
Card Number _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ Card Expiry Date ____ / ____
Cardholder's Name___________________________________________ Normal Card
Signature ______________________________________ In the event of a refund of
the lodging fee being applicable, the refund should be forwarded to:
Commission Use Only Receipt Number__________________________/Credit
Transaction Processed___________________
FORM R21 Rule 38
Australian Industrial Relations Commission Commission use only
Application in respect of termination of Date received
employmentÑNotice of Employer's Appearance Workplace Relations Act 1996 (Cth)
Section 170CE 1 File number as on application
2 Employee's full name as on Family name Given names
application Details of employer named on the application 3 Full name
4 Has the employee given your Yes No ÑIt is as in (3)
name correctly? 5 Address
Postcode
6 Contact person's name Family name Given names
Phone ( ) Fax ( )
7 Are you the true employer? Yes No ÑWho is?
Give details 8 Name of the award or agreement (including the Australian
Workplace Agreement) under which the employee was employed immediately prior
to the termination Is the award or agreement State
or Federal? Federal State
If State, name of State
9 Are you a Company ACN
Government authority Partnership
Sole trader Cooperative
Club Other ÑSpecify
Details of representative
10 Is anyone representing you? No go to 14 YesÑsolicitor,
employer organisation or other
representative 11 Name of solicitor's firm, employer organisation or other
representative 12 Address
Postcode 13 Contact person
Phone ( ) Fax ( )
Address for notices
14 Where do you want notices Address in 5-6 or
from the Commission sent? Address in 11-13
(Choose one only) Reasons for termination
15 Brief summary of reason/s (or attached)
given for termination Jurisdictional objection (if applicable) 16 Are there
any grounds on which you believe the Commission does not have jurisdiction to
hear this application? If so, please indicate whether you intend to object to
the Commission hearing the application. I object to the Commission hearing the
application on jurisdictional grounds * and wish to be heard and object to
conciliation before determination of this jurisdictional issue; OR
( * some of the jurisdictional issues are set out on the foot of this form for
your assistance) I object to the Commission hearing the application on
jurisdictional grounds and wish to be heard but do not object to conciliation
before determination of this jurisdictional issue; OR I do not object to the
Commission hearing the application and do not wish to be heard on this aspect
of the application.
(Tick whichever is applicable) Late lodgment (if applicable) 17 If the
application by your former employee has been lodged in the Commission more
than 21 days after the day on which the termination took effect, the
Commission must decide whether to accept the application. Subsection 170CE (8)
of the Workplace Relations Act 1996 provides that the Commission may accept an
application that is lodged out of time if the Commission considers that it
would be unfair not to do so. If the application by your former employee (a
copy of which has been provided to you) has been lodged out of time, please
indicate whether you intend to object to the Commission extending the time for
lodgment. I object to extension of time and wish to be heard and object to
conciliation before determination of the application to extend time; OR I
object to extension of time and wish to be heard but do not object to
conciliation before determination of the extension; OR I do not object to
extension of time and do not wish to be heard on this aspect of the
application.
(Tick whichever is applicable) Declaration I declare that all the facts in
this notice are correct and complete to the best of my knowledge
If a solicitor, employer organisation Signature of employer,
or other representative has prepared solicitor, employer
the application, that person must organisation or other
sign here representative
NOTE: THIS FORM MUST BE FILED WITH Date / /
THE INDUSTRIAL REGISTRY WITHIN 7 Name (print)
DAYS OF RECEIPT AND A COPY MUST BE Position
IMMEDIATELY GIVEN TO THE APPLICANT, Employer Solicitor
PERSONALLY, BY POST OR FACSIMILE Employer organisation
TRANSMISSION. Other
If you are objecting to the application on jurisdictional grounds please
indicate the basis of your objection if the particular ground/s are set out
hereunder:
the employee is not covered by a federal award or agreement **
the employer is not a constitutional corporation **
the employee was employed on a fixed term contract the employee was a casual
who was employed for a short period (as per reg 30B(3)) the employee was
serving a period of probation or a qualifying period the employee was a
trainee employed under an approved traineeship the employee was not covered by
an award and his/her remuneration exceeded the specified rate (see
accompanying information sheet for the specified rate)
** May only be a relevant jurisdictional objection in NSW, Qld, W.A., S.A. and
Tasmania
FORM R22 Rule 39
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF REPRESENTATIVE'S APPEARANCE 1. Title of Matter:
...................................................................... U No.
.................................. 2. Name of Solicitor or Representative
entering appearance*/ change of appearance*
...................................................................... 3.
Address for Service of Solicitor or Representative
......................................................................
......................................................................
......................................................................
...Facsimile:..................... 4. Appearance is entered on behalf of
applicant*/respondent*. 5. Signature of Solicitor or
Representative............................................. 6. Date of this
Notice ..........................................
* Omit whichever is inapplicable. NOTE: A COPY OF THIS NOTICE MUST BE
IMMEDIATELY GIVEN TO THE OTHER PARTY AT HIS OR HER ADDRESS FOR SERVICE EITHER
PERSONALLY, BY POST OR FACSIMILE TRANSMISSION.
FORM R23 Rule 43
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF DISCONTINUANCE Commission Reference U
.............................................. In the matter of
[name of employee]
and
[name of employer] The Applicant
*wholly discontinues this matter
*wholly discontinues this matter as part of the terms of settlement agreed to.
Dated: ....................................................... Signed:
......................................................................
................
[applicant/solicitor/union or other representative]
* Omit whichever is inapplicable. NOTE: AFTER FILING THIS NOTICE IN THE
INDUSTRIAL REGISTRY A COPY OF THIS NOTICE MUST BE GIVEN IMMEDIATELY TO THE
EMPLOYER AT HIS OR HER ADDRESS FOR SERVICE EITHER PERSONALLY, BY POST OR
FACSIMILE TRANSMISSION. Commission use only: Date Received:
FORM R24 Rule 44
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
Workplace Relations Act 1996
170CF ISSUE OF CERTIFICATE
(U No ..............................................)
[Member] [Place and date]
CERTIFICATE In accordance with subsection 170CF (2) of the
Workplace Relations Act 1996 , the Commission certifies that all reasonable
attempts to settle the matter by conciliation have been, or are likely to be,
unsuccessful so far as concerns* [Insert reference to the particular
subsection(s) of the Act which identify the ground or grounds where
conciliation is, or is likely to be, unsuccessful]. An assessment of the
merits has been indicated to the parties in the following terms: [Set out
terms of assessment]
* an application under section 170CE of the Act can be based on the ground or
grounds: . that the termination was harsh, unjust or unreasonable . of an
alleged contravention of section 170CK of the Act . of an alleged
contravention of section 170CL of the Act . of an alleged contravention of
section 170CM of the Act . of an alleged contravention of section 170CN of the
Act
(The Commission recommends that the applicant not pursue [Insert ground or
grounds it is recommended not be pursued]) BY THE COMMISSION: [Signature of
member] Member's Title NOTE: The applicant has seven days within which to
lodge a notice of election.
FORM R25 Rule 45
Australian Industrial Relations Commission Commission use only
Workplace Relations Act 1996 (Cth) Date Received:
NOTICE OF ELECTION TO PROCEED TO ARBITRATION OR TO BEGIN COURT PROCEEDINGS
UNDER SUBREGON 170CFA (1), (2), (3), (4) OR (5)
insert names of parties insert Commission
Reference No I,
................................................................., being the
applicant in the above matter, in respect of which the Commission has issued a
certificate dated...............................(you may indicate your
election* by placing a cross ý in the space provided below): Under subsection
170CFA (1) [ie. unfair only] elect as follows:
(i) to proceed to arbitration to determine whether the termination
was harsh, unjust or unreasonable OR
(ii) not to proceed Under subsection 170CFA (2) [ie. unfair &
notice] elect either, both, or neither of the following:
(i) to proceed to arbitration to determine whether the termination
was harsh, unjust or unreasonable AND/OR
(ii) to begin proceedings in a court of competent jurisdiction for
an order under section 170CR in respect of the alleged
contravention of section 170CM OR
(iii) neither of the above Under subsection 170CFA (3) [ie. unfair &
unlawful other than notice] elect to do either or neither of
the following:
(i) to proceed to arbitration to determine whether the termination
was harsh, unjust or unreasonable OR
(ii) to begin proceedings in the Court for an order under section
170CR in respect of the alleged contravention, or of any one or
more of the alleged contraventions Under subsection 170CFA (4)
[ie. unlawful only] elect to do either, both or neither of the
following:
(i) so far as concerns an alleged contravention of a section or
sections other than section 170CMÐto begin proceedings in the
Court for an order under section 170CR in respect of the
alleged contravention, or of any one or more of the alleged
contraventions AND/OR
(ii) so far as concerns an alleged contravention of section 170CMÐ
to begin proceedings in a court of competent jurisdiction for
an order under section 170CR in respect of the alleged
contravention OR
(iii) neither of the above Under subsection 170CFA (5) [ie. unfair &
notice & other unlawful] must elect:
(i) to do either or both of the things permitted in subsection
170CFA (2) being proceedings under s 170CFA (2) (c) AND/OR s
170CFA (2) (d) OR
(ii) to do either or both of the things permitted in subsection
170CFA (4) being proceeding under s 170CFA(4)(a) AND/OR s
170CFA(4)(b) OR
(iii) none of those things (*an election can only be made in
respect of the particular options relating to the ground or grounds identified
in the certificate as not Settled, or not likely to be Settled, by
conciliation) This section to be completed if the election is lodged more than
7 days after the day of issue of the certificate by the Commission under
subsection 170CF(2): My reason/s for seeking an extension of time to lodge
this election is/are: (or attached) .........................
.......................................... ...............................
Date name and signature of applicant or applicant's solicitor, union or
representative AFTER LODGING THIS NOTICE IN THE INDUSTRIAL REGISTRY A COPY OF
THIS NOTICE MUST BE GIVEN IMMEDIATELY TO THE EMPLOYER AT HIS OR HER ADDRESS
FOR SERVICE EITHER PERSONALLY, BY POST OR FACSIMILE TRANSMISSION NOTE: In the
event that an applicant elects to begin court proceedings, the lodgment of
this Notice of Election Form in the Industrial Registry will not have the
effect of commencing any such court proceedings. Consequently, in addition to
the lodgment of this Form in the Industrial Registry (and the giving of a copy
to the employer), it is incumbent upon the applicant to also commence such
proceedings before an appropriate court.
FORM R26 Rule 47
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR ORDER FOR COSTS UNDER REGON 170CJ In the matter of [short
title of matter and case reference] Application is made by [name of the party
seeking an order for costs] for an order for costs incurred in respect of an
application under section 170CE of the Act. The order is sought under
[particular subsection or subsections of section 170CJ which is or are
applicable] against [name of party against whom order is to be made ] The
grounds on which this application is made are as follows: [Set out in numbered
paragraphs the grounds upon which the application for costs is based]
Dated 19 .
[Signature of applicant]
FORM R27 Rule 48
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION UNDER DIVISION 2 OF PART VIB FOR CERTIFICATION OF AN
AGREEMENT THAT APPLIES ONLY TO A SINGLE BUSINESS OR PART OF
A SINGLE BUSINESS
(AGREEMENT BETWEEN AN EMPLOYER OR EMPLOYERS AND AN ORGANISATION OR
ORGANISATIONS OF EMPLOYEES)
(REGON 170LJ OR 170LL)
IN the matter of: [title of matter]
Application is made under Division 2 (Making agreements with constitutional
corporations or the Commonwealth) of Part VIB of the Act by [name of the
applicant(s)] for the certification of the attached written agreement between
[Insert names of parties to the agreement]. I [or We] seek to have this
application heard in [appropriate capital city].
* [name of Member] has assisted in facilitating the making of this agreement.
Dated 19 .
[Signature(s) of applicant(s)] Note: In respect of each party to the
agreement, the application must be accompanied by a statutory declaration in
accordance with Form R28.
* Omit if inapplicable.
FORM R28 Rule 48
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION STATUTORY DECLARATION IN RESPECT OF
AN APPLICATION UNDER DIVISION 2 OF
PART VIB FOR CERTIFICATION OF AN AGREEMENT THAT APPLIES ONLY TO A
SINGLE BUSINESS OR PART OF A SINGLE BUSINESS
(AGREEMENT BETWEEN AN EMPLOYER OR EMPLOYERS AND AN ORGANISATION
OR ORGANISATIONS OF EMPLOYEES)
(REGON 170LJ OR 170LL) An original and one copy of the signed statutory
declaration must be lodged with the application at an office of the Australian
Industrial Registry in a State or Territory. Each party to the agreement must
complete a separate statutory declaration.
The application must be accompanied by: . an original of the written agreement
signed by the parties to the agreement, . three copies for the use of the
Industrial Registry, and . sufficient additional copies to enable the
Industrial Registry to provide a copy of the agreement to each party in the
event of certification by the Commission. Answer all questions as directed. If
the space provided is insufficient, attach a separate sheet clearly marked
with the relevant part number. I, [name], of [address], [occupation], on whose
behalf this statutory declaration is made, do solemnly and sincerely declare
as follows: TITLE OF AGREEMENT
...................................................................... Part 1:
About the application This application is made under Division 2 (Making
agreements with constitutional corporations or the Commonwealth) of Part VIB
of the Act. Part 2: About the business 2.1 What is the single business or part
of a single business covered by the agreement?
...................................................................... 2.2
Name of business or place of work that is the single business covered by this
agreement
...................................................................... 2.3
Address of the place of work, or at which the business is carried out
...................................................................... 2.4
Does this agreement apply to the whole or only to a part of a single business?
If the agreement applies to the whole of the single business, proceed to Part
3. If the agreement applies only part of the single business, is the part of
the single business a geographically distinct part or a distinct operational
or organisational unit within the single business?
YES / NO (If YES, proceed to Part 3)
If NO, indicate the grounds why the Commission should not consider that:
(i) the agreement defines that part of the single business in a way
that results in the agreement not covering employees whom it
would be reasonable for the agreement to cover (see s 170LU
(8))
......................................................................
................................; and
(ii) it is not unfair for the agreement not to cover those employees
(see s 170LU (8))
......................................................................
Part 3: About the Employer(s) 3.1 Full name of employer(s)
......................................................................
........................................ 3.2 Please include
trading name(s) (if any)
......................................................................
3.3 Full address
......................................................................
.........................................................POSTCODE.....
3.4 Is/are the employer(s) either a constitutional corporation
or the Commonwealth?
YES / NO If YES, specify the information below and then
proceed to 3.8:
Employer’s Name Specify A.C.N. Number or source of corporate
status (or if employer is the Commonwealth,
source of Commonwealth status)
.................... ............................................
.................... ............................................
.................... ............................................
3.5 Is the agreement about matters pertaining to the relationship between an
employer who is carrying on a single business or part of a single business in
a Territory and employees employed in that single business or part? (see s 5AA
(2)) YES / NO (If YES, proceed to question 3.8) 3.6 Does the agreement pertain
to a relationship between:
(a) a waterside employer and waterside workers employed in a single
business or part of a single business of the waterside employer; or
(b) an employer and maritime employees employed in a single business or
part of a single business of the employer; or
(c) a flight crew officers' employer and flight crew officers performing
duties or being trained in a single business or part of a single
business of the employer; so far as the matters relate to trade or
commerce:
(d) between Australia and a place outside Australia; or
(e) between the States; or
(f) within a Territory, between a State and a Territory, or between 2
Territories? (see s 5AA (3)) YES / NO (If NO, proceed to 3.7) If YES,
does the relationship fall into: category (a), (b) and/or (c):
.......................; and category (d), (e) and/or (f):
....................... 3.7 Is the agreement about matters pertaining
to the relationship between:
(a) an employer (within the meaning of Part XV, Matters Referred by
Victoria) in Victoria who is carrying on a single business or part of
a single business; and
(b) employees (within the meaning of Part XV) in Victoria employed in the
single business or part? (see s 494 (2)) YES / NO Greenfields
Agreement 3.8 Does the agreement apply only to a new business that the
employer proposes to establish, or is establishing, and in which no
one is yet employed who will be subject to the agreement? YES / NO (If
NO, proceed to Part 4) If YES, when the agreement was made was each
organisation of employees which is a party to the agreement entitled
to represent the industrial interests of one or more of the persons,
whose employment is likely to be subject to the agreement, in relation
to work that will be subject to the agreement? YES / NO (If YES,
proceed to Part 4) If NO, specify the organisation(s) that were not so
entitled:
......................................................................
Part 4: About the Employee Organisation(s) party to the Agreement 4.1.
Name(s) of organisation(s) of employees that is/are party to this
agreement
......................................................................
Part 5: Involvement of Employee Organisations 5.1 In relation to each
organisation of employees party to the agreement: 5.1.1 does each
organisation have at least 1 member employed in the single business or
part of the single business whose employment will be subject to the
agreement? (see s 170LJ (1) (a)) (proceed to 5.1.2 if agreement is a
Greenfields Agreement) YES / NO If NO, specify the organisation(s)
which do not have at least 1 such member:
......................................................................
5.1.2 is each organisation entitled to represent the industrial
interests of its member(s) in relation to work which is the subject of
the agreement? (see s 170LJ (1) (b)) YES / NO If NO, specify the
organisation(s) which is/are not entitled to represent member(s):
......................................................................
Part 6: About the Employees
(Proceed to Part 7 if the agreement is a Greenfields Agreement) 6.1 Was the
agreement genuinely approved by a valid majority of persons employed at the
time whose employment will be the subject of the agreement? (see ss 170LE,
170LJ (2) and 170LT (5)) YES / NO If YES:
(i) specify the steps taken by the employer to give all employees
employed at a particular time whose employment is or will be
subject to the agreement a reasonable opportunity to decide
whether they want to give approval to the agreement: (see s
170LE (c))
......................................................................
.................................and;
(ii) did either:
* a majority of such employees, or
* where a decision was made by vote, a majority of such employees who cast a
valid vote decide or genuinely decide that they want to approve the agreement?
(see s 170LE (d)) YES / NO 6.2 On what date was the agreement approved by a
valid majority of employees or (where the agreement is a greenfields agreement
under s 170LL) made? [Note: The application to the Commission to certify the
agreement must be made no later than 21 days after this date] 6.3 State the
total number of employees covered by the agreement:
..................................................................... 6.4 Does
the agreement cover employees who are described in 6.5 below? (see s 170LT
(7)) YES / NO (If NO, proceed to 6.6) 6.5 Of the total number, how many
employees are:
women? .....................
persons from a non-English speaking background? .....................
under the age of 21 years? .....................
Aboriginal or Torres Strait Islanders? .....................
disabled persons? .....................
part-time employees? .....................
casual employees? .....................
6.6 At least 14 days before any approval was given, did the employer take
reasonable steps to ensure that every person employed at the time whose
employment will be subject to the agreement either had or had ready access to
the proposed agreement in writing?
(see s 170LR (2) (a)) YES / NO If YES, specify the steps taken:
...................................................................... 6.7
Before approval was given, were reasonable steps taken by the employer to
explain the terms of the agreement to employees subject to it? (see s 170LR
(2) (b)) YES/NO If YES, please specify the steps taken
...................................................................... 6.8 Did
the explanation of the terms of the agreement to the persons subject to it
take place in ways that were appropriate having regard to the persons
particular circumstances and needs? (For example, where the persons include
women, persons from a non-English speaking background or young persons) (see s
170LT (7)) YES/NO If YES, please state the ways used
...................................................................... Part 7:
About the Agreement 7.1 Are the terms and conditions of employment of
employees covered by the agreement regulated by relevant award(s) that is,
award(s) (including State award(s)), which:
(a) regulate any term or condition of employment of persons engaged in the
same kind of work as that of employees under the agreement; and
(b) expected to be binding on the employer immediately before the initial
day (that is, the day on which the agreement is certified by the
Commission)? (see ss 170X and 170XA) YES / NO If YES, specify the
award(s)
......................................................................
If NO, has application been made under section 170XF for a
determination of the award(s) which is/are designated appropriate for
the purpose of deciding whether the agreement passes the no-
disadvantage test? YES / NO If YES, specify the designated award(s):
......................................................................
and attach a copy of the Commission's determination 7.2 Would
certification result, on balance, in a reduction in the overall terms
and conditions of employment of employees covered by the agreement
under relevant or designated awards or laws of the Commonwealth, a
State or Territory? (see s 170XA (2)) YES / NO 7.3 Please identify, by
referring to specific clauses in the agreement, any reductions in
terms and conditions of employees under any relevant or designated
award or other law
(see s 170XA) (If there are no reductions proceed to 7.6.)
...................................................................... 7.4
Please identify, by referring to specific clauses in the agreement, any terms
and conditions which result, on balance, in there being no reduction in the
overall terms and conditions of employment of the employees under the
agreement. (see s 170XA)
...................................................................... 7.5
Where there has, on balance, been a reduction in overall terms and conditions
of employment, indicate any grounds on which the Commission should be
satisfied that certifying the agreement is not contrary to the public interest
(see s 170LT (2) and (3))
...................................................................... 7.6
Does the agreement include procedures for preventing and settling disputes
between the employer and the employees whose employment will be subject to the
agreement about matters arising under the agreement? (see s 170LT (8))
YES/NO If YES, Clause
................................................ 7.7 Does the agreement
specify a date as the nominal expiry date that is not more than 3 years after
the date on which the agreement will come into operation? (see s 170LT (10))
YES/NO If YES, what is the date specified? ......................... Clause
............... 7.8 Has the agreement ended a bargaining period? (see s 170MV
(a)) YES/NO If YES, state the bargaining case number(s) of the bargaining
period(s) ended: C No ____________________of _________ SIGNATURE And I make
this solemn declaration by virtue of the Statutory Declarations Act 1959 ,
and subject to the penalties provided by that Act for the making of false
statements in statutory declarations, conscientiously believing the statements
contained in this declaration to be true in every particular. [signature of
person making the declaration] Declared at [place] on [date]
Before me, [signature of person before whom the declaration is made] [title of
person before whom the declaration is made]
_______________________________________________________ For each organisation
of employees that is party to the agreement, include the following: Contact
person for receipt of hearing details concerning application (someone
authorised by the organisation to speak about the agreement on behalf of the
organisation): Full name:
......................................................................
Position:
...................................................................... Address
of contact person:
......................................................................
....................................................POSTCODE .........
Telephone number (business hours): ( )
......................................... Facsimile number: ( )
........................................
FORM R29 Rule 49
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION UNDER DIVISION 2 OF PART VIB FOR CERTIFICATION OF AN
AGREEMENT THAT APPLIES ONLY TO A SINGLE BUSINESS OR PART OF A
SINGLE BUSINESS
(AGREEMENT BETWEEN AN EMPLOYER OR EMPLOYERS AND EMPLOYEES)
(REGON 170LK) IN the matter of:
[title of matter] Application is made under Division 2 (Making agreements with
constitutional corporations or the Commonwealth) of Part VIB of the Act by
[name of the applicant(s)] for the certification of the attached written
agreement relating to [name of employer(s)]. I [or We] seek to have this
application heard in [appropriate capital city].
* [name of Member] has assisted in facilitating the making of this agreement.
Dated 19 .
[Signature(s) of applicant(s)] Note: The application must be accompanied by a
statutory declaration in accordance with Form R30 in respect of each
employer(s). Where the agreement was negotiated by an employee acting on his
or her own behalf and on behalf of other employees, a separate statutory
declaration in accordance with Form R30 completed by that employee should also
accompany the application.
* Omit if inapplicable.
FORM R30 Rule 49
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
STATUTORY DECLARATION IN RESPECT OF AN APPLICATION UNDER DIVISION 2
OF PART VIB FOR CERTIFICATION OF AN AGREEMENT THAT APPLIES ONLY
TO A SINGLE BUSINESS OR PART OF A SINGLE BUSINESS
(AGREEMENT BETWEEN AN EMPLOYER OR EMPLOYERS AND EMPLOYEES)
(REGON 170LK) An original and one copy of the signed statutory declaration
must be lodged with the application at an office of the Australian Industrial
Registry in a State or Territory. A statutory declaration is required in
respect of each employer. Where the agreement was negotiated with an employee
acting on his or her own behalf and on behalf of other employees, that
employee should also complete a statutory declaration. The application must be
accompanied by: . an original of the written agreement signed by the parties
to the agreement, . three copies for the use of the Industrial Registry, and .
sufficient additional copies to enable the Industrial Registry to provide a
copy of the agreement to each party in the event of certification by the
Commission. Answer all questions as directed. If the space provided is
insufficient, attach a separate sheet clearly marked with the relevant part
number. I, [name] of [address], [occupation], on whose behalf this statutory
declaration is made, do solemnly and sincerely declare as follows: TITLE OF
AGREEMENT
......................................................................
........................................ Part 1: About the application This
application is made under Division 2 (Making agreements with constitutional
corporations or the Commonwealth) of Part VIB of the Act. Part 2: About the
business 2.1 What is the single business or part of the single business
covered by the agreement?
...................................................................... 2.2
Name of business or place of work that is the single business covered by this
agreement
...................................................................... 2.3
Address of the place of work, or at which the business is carried out
...................................................................... 2.4
Does this agreement apply to the whole or only to a part of a single business?
If the agreement applies to the whole of the single business, proceed to Part
3. If the agreement applies only to a part of the single business, is the part
of the single business a geographically distinct part or a distinct
operational or organisational unit within the single business? YES / NO (If
YES, proceed to Part 3) If NO, indicate the grounds why the Commission should
not consider that:
(i) the agreement defines that part of the single business in a way
that results in the agreement not covering employees whom it
would be reasonable for the agreement to cover (see s 170LU
(8))
......................................................................
................................; and
(ii) it is not unfair for the agreement not to cover those employees
(see s 170LU (8))
......................................................................
Part 3: About the Employer(s) 3.1. Full name of employer(s)
......................................................................
3.2. Please include trading name(s) (if any)
......................................................................
3.3. Full address
......................................................................
......................................................................
..........................................POSTCODE...............
3.4 Is/are the employer(s) either a constitutional corporation
or the Commonwealth? YES / NO If YES, specify the information
below and then proceed to Part 4:
Employer’s Name Specify A.C.N. Number or source of corporate
status (or if employer is the Commonwealth,
source of Commonwealth status)
................. ...........................................
................. ...........................................
3.5 Is the agreement about matters pertaining to the relationship between an
employer who is carrying on a single business or part of a single business in
a Territory and employees employed in that single business or part? (see s 5AA
(2)) YES / NO (If YES, proceed to Part 4) 3.6 Does the agreement pertain to a
relationship between:
(a) a waterside employer and waterside workers employed in a single
business or part of a single business of the waterside employer; or
(b) an employer and maritime employees employed in a single business or
part of a single business of the employer; or
(c) a flight crew officers' employer and flight crew officers performing
duties or being trained in a single business or part of a single
business of the employer; so far as the matters relate to trade or
commerce:
(d) between Australia and a place outside Australia; or
(e) between the States; or
(f) within a Territory, between a State and a Territory, or between 2
Territories?
(see s 5AA (3)) YES / NO (If NO, proceed to 3.7) If YES, does the relationship
fall into: category (a), (b) and/or (c): .......................; and category
(d), (e) and/or (f): ....................... 3.7 Is the agreement about
matters pertaining to the relationship between:
(a) an employer (within the meaning of Part XV, Matters Referred by
Victoria) in Victoria who is carrying on a single business or part of
a single business; and
(b) employees (within the meaning of Part XV) in Victoria employer in the
single business or part? (see s 494 (2)) YES / NO Part 4: Involvement
of Employees/Employee Organisations 4.1 Was the agreement negotiated
with an employee acting on his or her own behalf and on behalf of
other employees? YES / NO If YES, indicate the facts which establish a
basis for the Commission to be satisfied that the employee is acting
on behalf of the other employees
......................................................................
4.2 Has an organisation of employees notified the employer in writing
that it wants to be bound by the agreement?
(see s 170M (3) (c)) YES / NO (If NO, proceed to Part 5) If YES, please
identify the organisation(s) of employees which have given notification:
..................................................................... 4.3 Does
each organisation of employees which has given notification have at least 1
member:
(i) whose employment will be subject to the agreement; and
(ii) whose industrial interests it is entitled to represent in
relation to work that will be subject to the agreement; and
(iii) who requested the organisation to give notification?
(see s 170M (3) (d)) YES / NO If NO, please identify the organisation(s) which
do not meet these criteria:
...................................................................... Part 5:
About the Employees 5.1 Was the agreement genuinely made with a valid majority
of persons employed at the time whose employment will be the subject of the
agreement?
(see ss 170LE, 170LK (1) and 170LT (6)) YES / NO If YES:
(i) specify the steps taken by the employer to give all employees
employed at a particular time whose employment is or will be
subject to the agreement a reasonable opportunity to decide
whether they want to make the agreement: (see s 170LE (c))
......................................................................
.................................and;
(ii) did either:
* a majority of such employees, or
* where a decision was made by vote, a majority of such employees who cast a
valid vote decide or genuinely decide that they want to make the agreement?
(see s 170LE (d)) YES / NO 5.2. On what date was the agreement made? [Note:
the application to the Commission to certify the agreement must be made no
later than 21 days after this date] 5.3 State the total number of employees
covered by the agreement:
.................................................................. 5.4 Does
the agreement cover employees who are described in 5.5 below? (see s 170LT
(7)) YES / NO (If NO, proceed to 5.6) 5.5 Of the total number, how many
employees are:
women? ................
persons from a non-English speaking background? ................
under the age of 21 years? ................
Aboriginal or Torres Strait Islanders? ................
disabled persons? ................
part-time employees? ................
casual employees? ................
5.6 Did the employer take reasonable steps to ensure that every person
employed at the time whose employment will be subject to the agreement have at
least 14 days’ notice, in writing, of intention to make the agreement? (see s
170LK (2)) [Note: the agreement must not be made before those 14 days have
passed] YES / NO If YES, specify the steps taken (including the date written
notice was provided by the employer of its intention to make the agreement)
...................................................................... 5.7 At
or before the time the notice was given, did the employer take reasonable
steps to ensure that every person employed at the time whose employment will
be subject to the agreement either had or had ready access to the proposed
agreement in writing?
(see s 170LK (3)) YES / NO If YES, specify the steps taken:
...................................................................... 5.8 Did
the notice given by the employer of intention to make the agreement state that
if:
(a) any person whose employment will be subject to the agreement is a
member of any organisation of employees; and
(b) the organisation is entitled to represent the person's industrial
interests in relation to work that will be subject to the agreement;
the person may request the organisation to represent the person in
meeting and conferring with the employer about the agreement? (see s
170LK (4)) YES / NO 5.9 If an organisation was so requested to
represent such a person, did the employer give the organisation a
reasonable opportunity to meet and confer with the employer about the
agreement before it was made? (see s 170LK (5)) YES / NO / NO REQUEST
WAS MADE TO THE ORGANISATION If YES, specify the grounds upon which it
is asserted that a reasonable opportunity was given:
......................................................................
5.10 Before agreement was made, were reasonable steps taken by the
employer to explain the terms of the agreement to employees subject to
it? (see s 170LK (7)) YES / NO If YES, please specify the steps taken
......................................................................
5.11 Did the explanation of the terms of the agreement to the persons
subject to it take place in ways that were appropriate having regard
to the persons particular circumstances and needs? (For example, where
the persons include women, persons from a non-English speaking
background or young persons) (see s 170LT (7)) YES / NO If YES, please
state the ways used
......................................................................
5.12.1 Was the proposed agreement so varied for any reason after the
notice referred to in 5.6 above was given? (see s 170LK (8)) YES / NO
(If NO, proceed to Part 6) 5.12.2 Each time the agreement was varied
were the steps referred to in 5.6, 5.7, 5.9 and 5.10 taken again in
relation to the proposed agreement as varied? (see s 170LK (8)) YES /
NO (If YES, proceed to 5.12.3) If NO, specify which steps referred to
in 5.6, 5.7, 5.9, and 5.10 were not taken again:
......................................................................
5.12.3 On what date(s) was written notice again provided by the
employer of its intention to make the agreement as varied? (see s
170LK (8)) Part 6: About the Agreement 6.1 Are the terms and
conditions of employment of employees covered by the agreement
regulated by relevant award(s) that is, award(s) (including State
award(s)), which:
(a) regulate any term or condition of employment of persons engaged in the
same kind of work as that of employees under the agreement; and
(b) expected to be binding on the employer immediately before the initial
day (that is, the day on which the agreement is certified by the
Commission)? (see ss 170X and 170XA) YES / NO If YES, specify the
award(s)
......................................................................
If NO, has application been made under section 170XF for a
determination of the award(s) which is/are designated appropriate for
the purpose of deciding whether the agreement passes the no-
disadvantage test? YES / NO If YES, attach a copy of the application
or the Commission's determination (if made) 6.2 Would certification
result, on balance, in a reduction in overall terms and conditions of
employment of employees covered by the agreement under relevant or
designated awards or laws of the Commonwealth, a State or Territory?
(see s 170XA (2)) YES / NO 6.3 Please identify, by referring to
specific clauses in the agreement, any reductions in terms and
conditions of employees under any relevant or designated award or
other law
(see s 170XA) (If there are no reductions proceed to 6.6.)
...................................................................... 6.4
Please identify, by referring to specific clauses in the agreement, any terms
and conditions which result, on balance, in there being no reduction in the
overall terms and conditions of employment of the employees under the
agreement. (see s 170XA)
......................................................................
....................................... 6.5 Where there has, on balance, been
a reduction in overall terms and conditions of employment, indicate any
grounds on which the Commission should be satisfied that certifying the
agreement is not contrary to the public interest (see s 170LT (2) and (3))
...................................................................... 6.6
Does the agreement include procedures for preventing and settling disputes
between the employer and the employees whose employment will be subject to the
agreement about matters arising under the agreement? (see s 170LT (8)) YES /
NO If YES, Clause............................................................
6.7 Does the agreement specify a date as the nominal expiry date that is not
more than 3 years after the date on which the agreement will come into
operation? (see s 170LT (10)) YES / NO If YES, what is the date specified?
........................... Clause .................... 6.8 Has the agreement
ended a bargaining period?
(see s 170MV (a)) YES / NO If YES, indicate the bargaining case number(s) of
the bargaining period(s) ended: C No _________________________ of _________
SIGNATURE And I make this solemn declaration by virtue of the Statutory
Declarations Act 1959 , and subject to the penalties provided by that Act for
the making of false statements in statutory declarations, conscientiously
believing the statements contained in this declaration to be true in every
particular. [signature of person making the declaration] Declared at [place]
on [date]
Before me, [signature of person before whom the declaration is made] [insert
title of person before whom the declaration is made] For each organisation of
employees that has notified the employer that it wants to be bound by the
agreement, include the following: Contact person for receipt of hearing
details concerning application (someone authorised by the organisation to
speak about the agreement on behalf of the organisation): Full
name:............................................................
Position:............................................................. Address
of contact person: ...........................................
.................................POSTCODE............................
Telephone number (business hours): ( ) ..............................
Facsimile number: ( ) ...............................................
FORM R31 Rule 50
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION UNDER DIVISION 3 OF PART VIB FOR CERTIFICATION OF AN
AGREEMENT THAT APPLIES ONLY TO A SINGLE BUSINESS OR PART OF
A SINGLE BUSINESS
(AGREEMENT BETWEEN AN EMPLOYER OR EMPLOYERS AND AN ORGANISATION
OR ORGANISATIONS OF EMPLOYEES)
(REGON 170LS) IN the matter of: [title of matter and original dispute
number(s)] Application is made under Division 3 (Making agreements about
industrial disputes and industrial situations) of Part VIB of the Act by [name
of the applicant(s)] for the certification of the attached written agreement
reached in settlement (or part settlement) of this matter between [names of
parties to agreement]. I [or We] seek to have this application heard in
[appropriate capital city].
*[name of Member] has assisted in facilitating the making of this agreement.
Dated 19 .
[Signature(s) of applicant(s)] Note: In respect of each party to the
agreement, the application must be accompanied by a statutory declaration in
accordance with Form R32.
* Omit if inapplicable.
FORM R32 Rule 50
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
STATUTORY DECLARATION IN RESPECT OF AN APPLICATION UNDER
DIVISION 3 OF PART VIB FOR CERTIFICATION OF AN AGREEMENT
THAT APPLIES ONLY TO A SINGLE BUSINESS OR PART OF A SINGLE
BUSINESS
(AGREEMENT BETWEEN AN EMPLOYER OR EMPLOYERS AND AN ORGANISATION
OR ORGANISATIONS OF EMPLOYEES)
(REGON 170LS) An original and one copy of the signed statutory declaration
must be lodged with the application at an office of the Australian Industrial
Registry in a State or Territory. Each party to the agreement must complete a
separate statutory declaration. The application must be accompanied by: . an
original of the written agreement signed by the parties to the agreement, .
three copies for the use of the Industrial Registry, and . sufficient
additional copies to enable the Industrial Registry to provide a copy of the
agreement to each party in the event of certification by the Commission.
Answer all questions as directed. If the space provided is insufficient,
attach a separate sheet clearly marked with the relevant part number. I,
[name] of [address], [occupation], on whose behalf this statutory declaration
is made, do solemnly and sincerely declare as follows: TITLE OF AGREEMENT
...................................................................... Part 1:
About the application This application is made under Division 3 (Making
agreements about industrial disputes and industrial situations) of Part VIB of
the Act. Part 2: About the business 2.1 What is the single business or part of
a single business covered by the agreement?
...................................................................... 2.2
Name of business or place of work that is the single business covered by this
agreement
...................................................................... 2.3
Address of the place of work, or at which the business is carried out
...................................................................... 2.4
Does this agreement apply to the whole or only to a part of a single business?
If the agreement applies to the whole of the single business, proceed to Part
3. If the agreement applies only to a part of the single business, is the part
of the single business a geographically distinct part or a distinct
operational or organisational unit within the single business? YES / NO (If
YES, proceed to Part 3) If NO, indicate the grounds why the Commission should
not consider that:
(i) the agreement defines that part of the single business in a way
that results in the agreement not covering employees whom it
would be reasonable for the agreement to cover (see s 170LU
(8))
..................................................................
............................; and
(ii) it is not unfair for the agreement not to cover those employees
(see s 170LU (8))
..................................................................
Part 3: About the Employer(s) 3.1. Full name of employer(s)
......................................................................
3.2. Please include trading name(s) (if any)
......................................................................
3.3. Full address
......................................................................
.....................................................POSTCODE.........
Part 4: About the Employee Organisation(s) party to the
Agreement 4.1. Name(s) of organisation(s) of employees that
is/are party to this agreement
......................................................................
Part 5: About the Employees 5.1 Was the agreement genuinely
approved by a valid majority of persons employed at the time
whose employment will be the subject of the agreement? (see ss
170LE, 170LR (1) and 170LT (5)) YES / NO If YES:
(i) specify the steps taken by the employer to give all employees
employed at a particular time whose employment is or will be
subject to the agreement a reasonable opportunity to decide
whether they want to give approval to the agreement: (see s
170LE (c))
......................................................................
................................ and;
(ii) did either:
* a majority of such employees, or
* where a decision was made by vote, a majority of such employees who cast a
valid vote decide or genuinely decide that they want to approve the agreement?
(see s 170LE (d)) YES / NO 5.2 On what date was the agreement approved by a
valid majority of employees? [Note: The application to the Commission to
certify the agreement must be made no later than 21 days after this date] 5.3
State the total number of employees covered by the agreement:
...................................... 5.4 Does the agreement cover employees
who are described in 5.5 below? (see s 170LT (7)) YES / NO (If NO, proceed to
5.6) 5.5 Of the total number, how many employees are:
women? ...............
persons from a non-English speaking background? ...............
under the age of 21 years? ...............
Aboriginal or Torres Strait Islanders? ...............
disabled persons? ...............
part-time employees? ...............
casual employees? ...............
5.6 At least 14 days before any approval was given, did the employer take
reasonable steps to ensure that every person employed at the time whose
employment will be subject to the agreement either had or had ready access to
the proposed agreement in writing? (see s 170LR (2) (a)) YES / NO If YES,
specify the steps taken:
...................................................................... 5.7
Before approval was given, were reasonable steps taken by the employer to
explain the terms of the agreement to employees subject to it? (see s 170LR
(2) (b)) YES / NO If YES, please specify the steps taken
...................................................................... 5.8 Did
the explanation of the terms of the agreement to the persons subject to it
take place in ways that were appropriate having regard to the persons
particular circumstances and needs?
(For example, where the persons include women, persons from a non- English
speaking background or young persons) (see s 170LT (7)) YES / NO If YES,
please state the ways used
...................................................................... Part 6:
About the Agreement 6.1 Identify the industrial dispute in settlement, further
settlement, maintenance of settlement or prevention of which the agreement is
made. (see s 170LN (a))
C No _______________ of ______
OR
Identify the facts on which it is asserted that the agreement is between
parties to an industrial situation and is for preventing the situation from
giving rise to an industrial dispute between them. (see s 170LN (b))
...................................................................... 6.2 Are
the terms and conditions of employment of employees covered by the agreement
regulated by relevant award(s) that is, award(s) (including State award(s)),
which:
(a) regulate any term or condition of employment of persons engaged in the
same kind of work as that of employees under the agreement; and
(b) expected to be binding on the employer immediately before the initial
day (that is, the day on which the agreement is certified by the
Commission)? (see ss 170X and 170XA) YES / NO If YES, specify the
award(s)
......................................................................
If NO, has application been made under section 170XF for a
determination of the award(s) which is/are designated appropriate for
the purpose of deciding whether the agreement passes the no-
disadvantage test? YES / NO If YES, specify the designated award(s):
......................................................................
and attach a copy of the Commission's determination 6.3 Would
certification result, on balance, in a reduction in the overall terms
and conditions of employment of employees covered by the agreement
under relevant or designated awards or laws of the Commonwealth, a
State or Territory? (see s 170XA (2)) YES / NO 6.4 Please identify, by
referring to specific clauses in the agreement, any reductions in
terms and conditions of employees under any relevant or designated
award or other law (If there are no reductions proceed to 6.7). (see s
170XA)
......................................................................
6.5 Please identify, by referring to specific clauses in the
agreement, any terms and conditions which result, on balance, in there
being no reduction in the overall terms and conditions of employment
of the employees under the agreement. (see s 170XA)
......................................................................
6.6 Where there has, on balance, been a reduction in overall terms and
conditions of employment, indicate any grounds on which the Commission
should be satisfied that certifying the agreement is not contrary to
the public interest (see s 170LT (2) and (3))
......................................................................
6.7 Does the agreement include procedures for preventing and settling
disputes between the employer and the employees whose employment will
be subject to the agreement about matters arising under the agreement?
(see s 170LT (8)) YES/NO If YES, Clause
................................................................ 6.8
Does the agreement specify a date as the nominal expiry date of the
agreement that is not more than 3 years after the date on which the
agreement will come into operation? (see s 170LT (10)) YES / NO If
YES, what is the date specified? ................................
Clause ................ 6.9 Has the agreement ended a bargaining
period? (see s 170MV (a)) YES/NO If YES, state the bargaining case
number(s) of the bargaining period(s) ended: C No
_______________________ of _______ SIGNATURE And I make this solemn
declaration by virtue of the Statutory Declarations Act 1959 , and
subject to the penalties provided by that Act for the making of false
statements in statutory declarations, conscientiously believing the
statements contained in this declaration to be true in every
particular. [signature of person making the declaration] Declared at
[place] on [date]
Before me, [signature of person before whom the declaration is made] [title of
person before whom the declaration is made] For each organisation of employees
that is party to the agreement, include the following: Contact person for
receipt of hearing details concerning application (someone authorised by the
organisation to speak about the agreement on behalf of the organisation): Full
name:.................................................................
Position:............................................................. Address
of contact person: ...........................................
......................................................................
.................................POSTCODE ................... Telephone number
(business hours): ( ) ............................ Facsimile number: ( )
..........................................
FORM R33 Rule 51
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR CERTIFICATION OF A MULTIPLE-BUSINESS AGREEMENT
UNDER PART VIB IN the matter of: [title of matter] Application is made under
Part VIB of the Act by [name(s) of applicant(s)] for the certification of the
attached memorandum of agreement.
Dated 19 .
Signature(s) of applicant(s) Note: In respect of each party to the agreement,
the application must be accompanied by a statutory declaration of the type
described in subrule 51 (3).
FORM R34 Rule 52
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR EXTENSION OF CERTIFIED AGREEMENT IN the matter of:
[title of certified agreement and case number] Application is made by [name of
applicant] for approval under section 170MC of the Act for the extension of
the nominal expiry date of the abovementioned agreement from [nominal expiry
date] until [date].
Dated 19 .
[Signature of applicant] Note: The application must be accompanied by:
(i) a statutory declaration made by a person authorised to do so
which indicates the facts which establish a basis for the
Commission to be satisfied that the requirements of subsection
170MC (3) of the Act are met; and
(ii) if one or more organisations are bound by the agreement, a
written statement signed by the employer and the one or more
organisations signifying their agreement to the extension.
FORM R35 Rule 53
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR APPROVAL OF VARIATION OF CERTIFIED AGREEMENT IN the matter of:
[title of certified agreement and case number] Application is made by [name of
applicant] for approval under subsection 170MD (2) of the Act to a variation
to the abovementioned agreement in the manner set out in the attachment.
Dated 19 .
[Signature of applicant] Note: The application must be accompanied by:
(i) a copy of the variation or varied agreement;
(ii) a statutory declaration made by a person authorised to do so
which indicates the facts which establish a basis for the
Commission to be satisfied that the requirements of subsection
170MD (2) of the Act are met;
(iii) if one or more organisations are bound by the agreement, a
written statement signed by the employer and the one or more
organisations signifying their agreement to the variation.
Where the application is made by the employer, the statutory
declaration mentioned in (ii) above must also state whether
approval to the variation is sought in accordance with a
request by one or more employees under subsection 170MDA (1) of
the Act.
FORM R36 Rule 54
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR ORDER TO VARY CERTIFIED AGREEMENT BY A PERSON
BOUND BY THE AGREEMENT IN the matter of:
[title of certified agreement and case number] Application is made by [name of
applicant] under subsection 170MD (6) of the Act for an order to vary the
abovementioned agreement in the manner set out in the attachment. The grounds
on which this application is made are as follows:
[Set out in numbered paragraphs the grounds]
Dated 19 .
[Signature of applicant] To all persons bound by this agreement. You are
notified this application will be heard by [name of member of the Commission]
at [time] on [date] at [place] and that you may appear and be heard at the
time and place so fixed.
Dated 19 .
[Signature]
Member of Commission
[or Registrar]
FORM R37 Rule 55
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR APPROVAL OF TERMINATION OF CERTIFIED AGREEMENT IN the matter
of:
[title of certified agreement and case number] Application is made by [name of
applicant] for approval under section 170MG of the Act for the termination of
the abovementioned agreement.
Dated 19 .
[Signature of applicant] Note: The application must be accompanied by:
(i) a statutory declaration made by a person authorised to do so
which indicates the facts which establish a basis for the
Commission to be satisfied that the requirements of subsection
170MG (3) of the Act are met; and
(ii) if one or more organisations are bound by the agreement, a
written statement signed by the employer and the one or more
organisations signifying their agreement to the termination.
FORM R38 Rule 56
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR TERMINATION OF CERTIFIED AGREEMENT IN PUBLIC
INTEREST AFTER NOMINAL EXPIRY DATE IN the matter of:
[title of certified agreement and case number] Application is made by [name of
applicant] under subsection 170MH (1) of the Act for the abovementioned
agreement to be terminated. The nominal expiry date of the agreement was
[date] The grounds on which this application is made are as follows:
[Set out in numbered paragraphs the grounds upon which it is claimed that it
is not contrary to the public interest to terminate the agreement]
Dated 19 .
[Signature of applicant] Note: Where the application is made by an appointed
representative of a majority of the employees whose employment is subject to
the agreement, the application must be accompanied by a statutory declaration
made by the representative which indicates the facts which establish a basis
for the Commission to be satisfied that the representative has been appointed
by the employees concerned and is acting in accordance with their direction.
FORM R39 Rule 57
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR APPROVAL OF TERMINATION OF CERTIFIED AGREEMENT
IN A WAY PROVIDED UNDER AGREEMENT AFTER NOMINAL EXPIRY DATE IN the matter of:
[title of certified agreement and case number] Application is made by [name of
applicant] for approval under subsection 170MHA (1) of the Act for the
termination of the abovementioned agreement. The nominal expiry date of the
agreement was [date]
Dated 19 .
[Signature of applicant] Note: The application must be accompanied by a
statutory declaration made by a person authorised to do so which indicates the
facts which establish a basis for the Commission to be satisfied that the
requirements of paragraphs (1) (a) and (b) of section 170MHA of the Act are
complied with.
FORM R40 Rule 58
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF INITIATION OF BARGAINING PERIOD Under subsection 170MI (2) of the
Act, notice is given to the Australian Industrial Relations Commission, that
[name and address of initiating party],
* an employer
* an organisation of employees
* an employee acting on his or her own behalf and on behalf of other employees
intends to try:
(a) to make an agreement under Division 2 [or 3] of Part VIB of the Act
with [names and addresses of other negotiating parties]; and
(b) to have any agreement so reached certified under Division 4 of Part
VIB of the Act. Particulars as specified in section 170MJ of the Act
are:
[Set out particulars] The Commission is [or is not] being asked to exercise
powers to try by conciliation to facilitate the making of such an agreement.
Dated 19 .
[Signature of initiating party]
* Omit whichever is inapplicable.
FORM R41 Rule 59
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF THE GIVING OF AUTHORISATION TO ENGAGE IN INDUSTRIAL
ACTION IN the matter of a bargaining period between [names of negotiating
parties] arising in matter [bargaining case number]. Under section 170MR of
the Act, notice is given to the Registrar that the members of [name of
organisation of employees] have been authorised to engage in industrial
action, within the bargaining period, against [name of particular employer].
The authorisation was given by [name of the relevant committee of management
of the organisation or person authorised by that committee to authorise the
action] in accordance with:
[Insert reference to the rule under which the action is authorised, if the
organisation's rules provide for how industrial action is to be authorised].
[Signature of person giving notice]
FORM R42 Rule 60
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION TO SUSPEND OR TERMINATE BARGAINING PERIOD IN the matter of a
bargaining period between [names of negotiating parties] arising in matter
[the bargaining case number]. Application is made by [name of applicant] under
subsection 170MW (8) of the Act for an order of the Commission to suspend or
terminate the abovementioned bargaining period. The grounds on which this
application is made are as follows:
[Set out in numbered paragraphs the grounds and particulars of the grounds]
Dated 19 .
[Signature of applicant]
FORM R43 Rule 61
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR REVOCATION OF AN AWARD MADE UNDER REGON 170MX In the matter of
[name of award made under section 170MX of the Act] Application is made by
[name of notifier] under subsection 170MZ (4) of the Act for revocation of the
abovementioned award. The grounds on which this application is made are as
follows:
[Set out the grounds in numbered paragraphs]
Dated 19 .
[Signature of applicant]
FORM R44 Rule 62
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
REQUEST TO TERMINATE AWARD MADE UNDER REGON 170MX In the matter of [name of
award made under section 170MX of the Act] Under subsection 170MZ (5) of the
Act, notice is given by [name of notifier] requesting the Commission terminate
the abovementioned award. The grounds on which this request is made are as
follows:
[Set out the grounds in numbered paragraphs]
Dated 19 .
[Signature of applicant]
FORM R45 Rule 63
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR DETERMINATION OF DESIGNATED AWARD OR AWARDS
FOR THE PURPOSES OF A CERTIFIED AGREEMENT In the matter of: [title of
proposed* agreement] Application is made under subsection 170XF (2) of the Act
for the Commission to determine an appropriate award or award for the purpose
of deciding whether a certified agreement passes the no-disadvantage test. The
kind of work that the persons under the proposed* agreement are engaged in is
[description of kind of work]. To the best of my knowledge and belief, the
[name of award(s) under the Act] may be appropriate for the purpose of
deciding whether the agreement passes the no-disadvantage test.
Dated 19 .
[Signature of applicant]
* The reference to "proposed agreement" indicates that a determination under
subsection 170XF (2) may be sought prior to an agreement being lodged in the
Commission for certification.
FORM R46 Rule 64
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
SUMMONS TO WITNESS IN the matter of:
[title of matter and case number] To [name(s), address(es) and position(s) of
witness(es)] You are summoned to attend before [name of member of the
Commission] at [time] on [date] at [place] and so from day to day until the
hearing of the abovementioned matter is completed or until you are excused
from further attendance, to give evidence on behalf of [name of party].
* You are required to bring with you and produce the following documents and
other things:
[Set out documents and other things required]
Dated 19 .
[Signature]
Member of Commission
[or Registrar]
* Omit if inapplicable.
FORM R47 Rule 66
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE UNDER A DISPUTE SETTLING PROCEDURE IN AN AGREEMENT NOTICE is given by
[name of notifier] to the Commission under clause [clause number of dispute
settling procedure] of [name, type and parties to agreement*]. The matter in
dispute relates to [description of matters in dispute]. The following steps of
the dispute settling procedure have been taken: [Insert steps taken and
enclose a copy of the dispute settling procedure].
Dated 19 .
[Signature of notifier]
* Identify whether agreement is a certified agreement, Australian Workplace
Agreement or an employment agreement referred to in section 520 of the
Workplace Relations Act 1996.
FORM R48 Rule 67
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR REMOVAL OF OBJECTIONABLE PROVISIONS IN the matter of: [title
of award or certified agreement] Application is made by [name of applicant]
for the abovementioned award [or certified agreement] to be varied to remove
the following objectionable provisions:
[Set out the provisions sought to be removed] The grounds on which this
application is made are as follows:
[Set out in numbered paragraphs the grounds]
Dated 19 .
[Signature of applicant] To the applicant and to the other parties to the
award [or the other persons bound by certified agreement]: You are notified
that the abovementioned application will be heard by the Commission at [time]
on [date], at [place], and that you may appear and be heard at the time and
place so fixed.
Dated 19 .
[Signature]
Member of Commission
[or Registrar]
FORM R49 Rule 68
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR MINIMUM WAGE ORDER FOR CERTAIN VICTORIAN EMPLOYEES Application
is made by [name of applicant and statement of the basis on which the
applicant is able to make the application] for the making of an order setting
/ adjusting * a minimum wage for employees within the work classification
described as follows [description of work classification]. The order sought
is: [Set out the terms of the order sought including any group of employees to
be specified in the order] The grounds on which this application is made are
as follows: [Set out in numbered paragraphs the grounds, including the
particulars of the grounds] The following employee organisations and employer
organisations may, to the best of the knowledge and belief of the applicant,
have an interest in the matter:
[Set out employee organisations and employer organisations which may have an
interest in the matter] The following employer(s) may, to the best of the
knowledge and belief of the applicant, have an interest in the matter:
[Set out employer(s) who may have an interest in the matter]
Dated 19 .
[Signature of applicant]
* Omit whichever is inapplicable. Omit unless applicant is an employee, or
group of employees, within a work classification the subject of the
application.
FORM R50 Rule 68
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF HEARING FOR APPLICATION FOR MINIMUM WAGE ORDER FOR
CERTAIN VICTORIAN EMPLOYEES IN the matter of:
[case number] Notice is givenÐ
(a) that on [date] the Commission received an application for the setting
[or adjusting] of a minimum wage in respect of the undermentioned work
classification:
[description of work classification];
(b) that the matter will be heard at [time] on [date] at [place] before
[name of Commission Member]; and
(c) that each employee organisation who is entitled to represent the
industrial interests of one or more of the employees within the work
classification the subject of the application and each employer
organisation of which an employer of any of those employees is a
member and wishing to be heard in relation to the application is
invited to attend the Commission on the abovementioned date; and
(d) that any employer of employees within the work classification the
subject of the application and wishing to be heard in relation to the
application is invited to attend the Commission on the abovementioned
date. A copy of the application may be inspected free of charge at the
Australian Industrial Registry at [address] or at the following
places:
[Signature]
Registrar
FORM R51 Rule 73
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR AN ORDER FOR SUBSTITUTED SERVICE IN the matter of:
[title of matter and case number] Application is made by [name of applicant]
for an order for substituted service for the service otherwise required by the
Australian Industrial Relations Commission Rules in the above matter and that
service upon the undermentioned parties be good and sufficient service and be
effected by [Set out method of service]:
[Set out names and addresses] The grounds on which this application is made
are as follows:
[Set out the grounds in numbered paragraphs, including particulars of the
number of parties to the award and difficulties likely to be encountered in
effecting prompt service to all those parties under the Commission's Rules and
details showing that the parties Set out above or their representatives
appeared when the award was previously before the Commission.]
Dated 19 .
[Signature of applicant] Note: The application should be supported by a
written statement in the following terms: I, [name], am the [position held],
of [name of organisation, company etc] and I am authorised to act in this
matter.
[Signature of applicant]
FORM R52 Rule 75
Occupational Health and Safety (Commonwealth Employment) Act 1991
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION REVIEWING AUTHORITY
REFERRAL OF DISAGREEMENT CONCERNING MANNER OF ESTABLISHING OR
VARYING A DESIGNATED WORK GROUP Notice is given under subsection 24 (4) of the
Act by [name of notifier] of a disagreement in the course of consultation
concerning the manner of establishing or varying a designated work group. The
parties to the consultation are: [names and addresses of parties to the
consultation]
Dated 19 .
[Signature of notifier]
FORM R53 Rule 76
Occupational Health and Safety (Commonwealth Employment)
Act 1991
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION REVIEWING AUTHORITY
NOTICE OF APPEAL UNDER REGON 48 IN the matter of: [title of matter] Notice of
an appeal under section 48 of the Occupational Health and Safety
(Commonwealth Employment) Act 1991 is given by [name and address of appellant]
against a decision of [name of investigator], an investigator, on [date of
decision] to [Insert details of decision with specific reference to the
categories listed in paragraphs 48 (1) (a)-(f) or 48 (2) (a)-(b)]. I make the
appeal as I am [Insert details of the basis on which the appellant claims the
right to appeal with specific reference to the categories listed in paragraphs
48 (1) (g)- (n) or 48 (2) (c)-(e)]. The grounds of this appeal are as follows:
[Set out in numbered paragraphs the grounds on which the appeal is based] A
copy of this Notice of appeal and documents lodged in accordance with subrule
39 (1) will as soon as practicable be served on the following persons: [Insert
names and addresses of persons required to be served under subrule 39 (6) or
(7) as the case may be]
Dated 19 .
[Signature of appellant] [Note: If it is intended to seek an order under
subsection 48 (3) of the Act that the making of the appeal affect the
operation of the decision or prevent the taking of action to implement the
decision, the notice of appeal must include an application to that effect, as
set out below: "Application is also made for an order that the making of the
appeal affect the operation of the decision or prevent the taking of action to
implement the decision." If it is intended to seek an order under subsection
48 (4) or (5) of the Act that the operation of the decision under section 47,
or notice under section 29, of the Act, as the case may be, not be suspended
pending determination of the appeal, the notice of appeal must include an
application to that effect, as set out below: "Application is also made for an
order under
* subsection 48 (4) that the operation of the decision under section 47
* subsection 48 (5) that the operation of a notice under section 29 of the Act
not be suspended pending determination of the appeal."
* Omit whichever is inapplicable.]
FORM R54 Rule 76
Occupational Health and Safety (Commonwealth Employment)
Act 1991
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION REVIEWING AUTHORITY
APPLICATION FOR AN EXTENSION OF TIME FOR INSTITUTING AN APPEAL IN the matter
of:
[title of matter] Application is made by [name and address of appellant] for
an extension of time for instituting an appeal against a decision of [name of
investigator] an investigator on [date of decision] to [details of decision
with specific reference to the categories listed in paragraphs 48 (1) (a)-(f)
or 48 (2) (a)-(b)]. I make the application as I am [Insert details of the
basis on which the appellant claims the right to appeal with specific
reference to the categories listed in paragraphs 48 (1) (g)-(n) or 48 (2)
(c)-(e)]. The grounds of this application are as follows: [Set out in numbered
paragraphs the grounds on which it is claimed an extension of time should be
granted]
Dated 19 .
[Signature of appellant]
FORM R55 Regulation 16
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR COMMON RULE IN the matter of:
[title of award and case number] Application is made by [name of applicant]
for a declaration that the terms hereinafter mentioned be a common rule
* in the [Territory] for the [industry]
* for the whole or a specified class of public sector employment named
hereunder.
[Set out particulars]
TERMS TO WHICH APPLICATION APPLIES
[Set out terms]
Dated 19 .
[Signature of applicant]
* Omit whichever is inapplicable.
FORM R56 Regulation 16
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF APPLICATION FOR COMMON RULE DECLARATION IN the matter of:
[title of award and case number] Notice is given that [name of applicant] has
made application for a declaration that the terms hereinafter mentioned be a
common rule:
* in the [Territory] for the [industry]
* for the whole or a specified class of public sector employment named
hereunder.
[Set out particulars] A copy of the award may be inspected free of charge at
the Australian Industrial Registry at [address] or at the following places:
The application will be heard at [place] on [date] before[name]. If you desire
to be heard on the hearing of the application, notice to that effect must be
given to the Commission. Persons and organisations not so appearing or
represented will be bound by any declaration made by the Commission in the
matter which is applicable to them.
TERMS TO WHICH APPLICATION APPLIES
[Set out terms]
Dated 19 .
[Signature]
Registrar
* Omit whichever is inapplicable.
FORM R57 Regulation 18
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF APPEARANCE TO OBJECT TO AN APPLICATION FOR COMMON RULE IN the matter
of:
[title of award and case number] And in the matter of an application to
declare the award (or part thereof) a common rule of the [Specify Territory
and industry or whole (or class) of public sector employment]. Take notice
that [name] claims to be interested in, and desires to be heard on the hearing
of, the application in the above matter. The objection relates to the
following matters:
[Set out in numbered paragraphs the terms objected to and the grounds of
objection.]
Dated 19 .
[Signature of applicant]
FORM R58 Regulation 21
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF APPLICATION FOR COMMON RULE DECLARATION IN the matter of:
[title of award and case number] Notice is given that [name of applicant] has
made application for a declaration that the terms hereinafter mentioned be a
common rule:
* in the [Territory] for the [industry]
* for the whole or a specified class of public sector employment named
hereunder. [Specify particulars] A copy of the award may be inspected free of
charge at the Australian Industrial Registry at [address] or at the following
places: The application will be heard at [place] on [date] before [name]. If
you desire to be heard on the hearing of the application, notice to that
effect must be given to the Commission. Persons and organisations not so
appearing or represented will be bound by any declaration made by the
Commission in the matter which is applicable to them.
TERMS TO WHICH APPLICATION APPLIES
[Set out terms]
Dated 19 .
[Signature]
Registrar
* Omit whichever is inappropriate.
FORM R59 Regulation 22
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF HEARING OF APPLICATION TO VARY A COMMON RULE AWARD IN the matter of:
[title of award and case number] AND in the matter of an application to vary
the abovementioned award. Notice is given:
(a) that this matter involves the variation of the term (or each of the
terms) of the above-mentioned award referred to in the Schedule below.
(b) that the term (or each of the terms) so referred to is (or are) a
common rule of the [Specify Territory and industry or whole (or
specified class) of public sector employment, (as the case requires)]
and
(c) the matter will be heard at [time] on [date] before [name]. A copy of
the award (or order) may be inspected free of charge at the Australian
Industrial Registry at [address] or at the following places:
SCHEDULE
TERMS TO BE VARIED
Clause No. Subject Substance of variation
Dated 19 .
[Signature]
Registrar
FORM R60 Regulation 23
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
NOTICE OF VARIATION OF COMMON RULE AWARD IN the matter of:
[title(s) and code number(s) of award(s) and case number(s)] AND in the matter
of the variation of the above award(s) Notice is given
(a) that the Commission has varied the term (or terms) of the above-
mentioned award(s) referred to in the Schedule below.
(b) that the variation(s) will be a common rule of the [Specify Territory
and industry or whole (or specified class) of public sector employment
(as the case requires)] as shown in the Schedule below; and
(c) that any organisation or person interested and having an objection to
the variation(s) binding that person or organisation and wanting to be
heard in relation to the abovementioned variation is invited to lodge
with the Commission a notice of that objection. A copy of the award(s)
may be inspected free of charge at the office of the Australian
Industrial Registry at [address] or at the following places:
SCHEDULE OF TERMS TO BE VARIED
Print Number Award
Code &Var No Clause No Substance of variation Date of Effect
Dated 19 .
[Signature]
Registrar
FORM R61 Regulation 24
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
DECLARATION OF COMMON RULE APPLICATION NOT BINDING ON
ORGANISATION OR PERSON IN the matter of:
[title of award and case number] AND in the matter of the variation of the
abovementioned award Notice is given
(a) that, on [date] the Commission varied the term (or terms) of the
above-mentioned award referred to in the Schedule below;
(b) that the variation is (or will be) a common rule of the [Specify
Territory and industry or whole (or specified class) of public sector
employment, (as the case requires)] with effect from [date]; and
(c) that, on [date], the Commission, in accordance with subsection 142
(6) of the Workplace Relations Act 1996, declared that the variation
(or part thereof) is not binding on [person or organisation].
SCHEDULE
TERMS TO BE VARIED
Print Number
Clause No. Subject Substance of variation
Dated 19 .
[Signature]
Registrar
FORM R62 Regulation 33
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION BY AN ASSOCIATION OF EMPLOYERS FOR REGISTRATION AS
AN ORGANISATION We, [full names, addresses and occupations of applicants],
make application for the registration of an association of employers called
[name of the association], the office of which is situated at [address of the
office of the association], as an organisation under the
Workplace Relations Act 1996, and we state as follows : 1. that the
association meets the criteria required by paragraphs 189 (1) (a), (b) and
(d)-(j) inclusive of the Act;
[Set out in respect of each of the paragraphs the grounds on which the
association relies] 2. that the eligibility rules of the association are:
[Insert the rules of the association that relate to the conditions of
eligibility for membership and the description of the industry (if any) in
connection with which the association is proposed to be registered]; and 3.
that we, the applicants, are officers of the association, and are authorised
to make this application.
Dated 19 .
[Signatures of applicants*]
Offices held [*Note: This application must be signed by 2 or more officers of
the association, including the officer who makes the statutory declaration
required by paragraph 33 (1) (b) of the Regulations.]
FORM R63 Regulation 33
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION BY AN ASSOCIATION OF EMPLOYEES (OTHER THAN AN
ENTERPRISE ASSOCIATION) FOR REGISTRATION AS AN ORGANISATION We, [full names,
addresses and occupations of applicants], make application for the
registration of an association of employers called [name of the association],
the office of which is situated at [address of the office of the association],
as an organisation under the Workplace Relations Act 1996, and we state as
follows : 1. that the association meets the criteria required by paragraphs
189 (1) (a), (aa) and (c)-(j) inclusive of the Act;
[Set out in respect of each of the paragraphs the grounds on which the
association relies] 2. that the eligibility rules of the association are:
[Insert the rules of the association that relate to the conditions of
eligibility for membership and the description of the industry (if any) in
connection with which the association is proposed to be registered]; and 3.
that we, the applicants, are officers of the association, and are authorised
to make this application.
Dated 19 .
[Signatures of applicants*]
Offices held [*Note: This application must be signed by 2 or more officers of
the association, including the officer who makes the statutory declaration
required by paragraph 33 (1) (b) of the Regulations.]
FORM R64 Regulation 33
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION BY AN ENTERPRISE ASSOCIATION OF EMPLOYEES FOR
REGISTRATION AS AN ORGANISATION We, [full names, addresses and occupations of
applicants], make application for the registration of an association of
employers called [name of the association], the office of which is situated at
[address of the office of the association], as an organisation under the
Workplace Relations Act 1996, and we state as follows : 1. that the
association meets the criteria required by subsection 189 (4) of the Act;
[Set out in respect of each of the paragraphs the grounds on which the
association relies] 2. that the eligibility rules of the association are:
[Insert the rules of the association that relate to the conditions of
eligibility for membership and the description of the industry (if any) in
connection with which the association is proposed to be registered]; and 3.
that we, the applicants, are officers of the association, and are authorised
to make this application.
Dated 19 .
[Signatures of applicants*]
Offices held [*Note: This application must be signed by 2 or more officers of
the association, including the officer who makes the statutory declaration
required by paragraph 33 (1) (b) of the Regulations.]
FORM R65 Regulation 39
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR LEAVE TO CHANGE NAME*/AND TO ALTER RULES* The [name of
association], which has applied for registration as an organisation, applies
to the designated Presidential Member for leave to change its name*/to alter
its rules*/to change its name and alter its rules* to enable it to comply with
the Act*/and to remove a ground of objection taken by an objector under the
Regulations*/and by the Presidential Member*. Particulars of the proposed
change of name*/and alterations of the rules* are as follows:
[Set out text of proposed change or alterations.]
Dated 19 .
[Signature]
* Omit if inapplicable.
FORM R66 Regulation 48
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR CONSENT TO THE CHANGE OF NAME OF AN ORGANISATION Application
is made by [name of organisation] for consent to the change of the name of the
said organisation to: [Set out proposed new name.]
Dated 19 .
[Signatures or Common Seal]*
* An application shall be sealed with the common seal of the organisation or
be signed by 2 officers of the organisation who are authorised by the
organisation to sign the application. Note: The application is to be
accompanied by a written statement, signed by one of the above setting out the
proposed name and the reason for the proposal, and providing details
concerning compliance with the rule altering procedure, and stating that the
particulars set out in the application are true and correct to the best
knowledge and belief of the signatory.
FORM R67 Regulation 48
Workplace Relations Act 1996
AUSTRALIAN INDUSTRIAL RELATIONS COMMISSION
APPLICATION FOR CONSENT TO THE ALTERATION OF ELIGIBILITY RULES
OF AN ORGANISATION Application is made by [name of organisation] for consent
to the alteration of the eligibility rules of the organisation from the
following:
[Insert present rules that relate to the conditions of eligibility for
membership and the description of industry (if any) in connection with which
the organisation is registered]. to the following:
[Insert proposed rules that relate to the conditions of eligibility for
membership and the description of industry (if any) in connection with which
the organisation is registered.]
Dated 19 .
[Signatures or Common Seal]*
* An application must be sealed with the common seal of the organisation or be
signed by 2 officers of the organisation who are authorised by the
organisation to sign the application. Note: The application shall be
accompanied by a written statement, signed by one of the above, setting out,
in sufficient particularity to allow the proposal to be properly considered,
the following: 1. The particulars of the proposed alteration. 2. The reason
for the proposed alteration. 3. The effect of the proposed alteration. and
providing details concerning compliance with the rule altering procedure and
stating that the particulars set out in the application are true and correct
to the best knowledge and belief of the signatory.
FORM R68 Regulation 99
Workplace Relations Act 1996
APPLICATION FOR CERTIFICATE UNDER
REGON 267
I, [full name] of [private address] (Telephone Nos. Business Home ),
apply under section 267 of the Workplace Relations Act 1996, for a certificate
to the effect that my conscientious beliefs do not allow me to be a member of
an association of a kind described in paragraph 188 (1) (a) or 188 (1) (b) of
the Act. My occupation is The name and address of my business/employer* is The
grounds on which my application is made are as follows:
[Set out in numbered paragraphs the grounds and particulars] I attach a
statutory declaration verifying the information stated in this application.
Dated 19 .
[Signature of applicant]
* Omit whichever is inapplicable.
FORM R69 Regulation 100
Workplace Relations Act 1996
APPLICATION FOR RENEWAL OF CERTIFICATE UNDER REGON 267
I, [full name] of [private address] (Telephone Nos. Business Home),
apply under section 267 of the Workplace Relations Act 1996, for a certificate
to the effect that my conscientious beliefs do not allow me to be a member of
an association of a kind described in paragraph 188 (1) (a) or 188 (1) (b) of
the Act. My occupation is The name and address of my business/employer* is The
grounds on which my application is made are as follows:
[Set out in numbered paragraphs the grounds and particulars] I attach a
statutory declaration verifying the information stated in this application.
Dated 19 .
[Signature of applicant]
* Omit whichever is inapplicable.
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