PERSONAL DETAILS FORM – CONFIDENTIAL

PERSONAL DATA

Title*

Full Name*

Address*

Street Address

Address Line 2

City

State / Province / Region

ZIP / Postal Code

Country

Phone*

Email*

Date of Birth*

Role

Please state your role or creative skill within the organisation

Business Entity*

Sole Trader, Company, Partnership, etc

ABN

Tax File Number

Company Name (if applicable)

Trading Name (if applicable)

EMERGENCY CONTACT

Emergency Contact*

Emergency Contact Relationship*

Emergency Contact Phone*

TRAVEL PREFERENCES

Full Name (as written on official form of ID, i.e. passport, drivers license)*

Do you have a Drivers License?

Please specify

eg. Open Auto / Manual

APRA #

For extra musicians baggage on flights

VIRGIN Velocity #

QANTAS Frequent Flyer #

Seating Preference

Window

Aisle

No preference

WORKING WITH CHILDREN CHECK

Blue Card #

Blue Card Expiry Date

BANKING DETAILS

Name of Bank*

Account Name*

BSB*

Account #*

Account Type

SUPERANNUATION DETAILS

Name of Fund*

Super Fund ABN*

Super Fund USI #*

Address of Fund

Policy / Member #*

MEDICAL STATEMENT – Confidential

Have you ever had, or do you currently have any illness, injury or known physical or medical condition (including known hearing loss) which could affect your ability to do this job?

Please specify*

Do you have any known allergies or sensitivities?

Please specify*

Do you have any specific dietary requirements?

Please specify*

In any previous employment have you been the subject of a claim for Workers Compensation for work related illness or injury?

Please specify*

Name of Employer | Month/Year | Nature of Illness/Injury | Period of Claim

CERTIFICATION

I certify that the above information is complete, correct and that full disclosure has been made.*

Full Name, Date

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