Department of Human Services

Tenant Employee Registration Form

The symbol indicates required information.

Any data submitted using this electronic form via the Internet is secure and will be encrypted using SSL (Secure Sockets Layer)

If you Employ a Public Housing Tenant please complete this form with the details of your company and your employee.



Name of Employer
Address
Suburb
Post Code
Contact Person
Phone Number
Occupation/Job Title
Average Hours Per Week
Start Date
Mode of Employment	Full Time Part time Casual
Job Type	Normal Traineeship Apprenticeship
DHS Contractor (if applicable)



Given Name
Family Name
Date of Birth
Gender	Male Female
Country of Birth
Address
Suburb	Post Code
Home Phone	Mobile No
E-mail
Date of Last Employment of 15 hours or more per week
Please indicate if any of the following apply to Employee	Person with a Physical Disability Person with a Intellectual Disability Person with a Mental Illness Indigenous or Torres Stait Islander Person from Culturally & Linguisticlly Diverse Communities
Is the Employee registered with a job Network?
Yes No
Name of Job Network	Location