Personal Details Form
Please return prior to commencement with your Tax Declaration form.
Please Print
Preferred title: (e.g. Dr/Prof/Mr/Mrs/Miss/Ms/Mx)
First/Given name:
Other name(s):
Preferred name:
(if different than first name)
Last/Family name:
Current address:
Contact phone no:
(Home)
(Mobile)
E-mail:
Date of birth:
(used for the age profile of our workforce)
Gender: (e.g. male/female/other)
(used for statutory government reporting purposes)
Emergency contact (1)
Emergency contact (2)
Name:
Name:
Relationship:
Relationship:
Contact number:
Contact number:
Optional
(This information assists the University in complying with statutory reporting requirements for both State and Federal Governments.)
Country of Origin:
Language spoken at home:
Aboriginal/Torres Strait Islander:
YES
☐
/ NO
☐
Whole of Pay Account
Bank name
Bank address
(where branch account is maintained)
Name in which account is held:
Bank/State/Branch Number
(BSB – six digits)
Account Number
(maximum nine digits)
Note: DO NOT use Visa, MasterCard, Bankcard, or KeyCard numbers
- these are not acceptable as your account number.
Signed:
Date:
FedUni’s Privacy Collection statement is located at http://policy.federation.edu.au/university/general/information_privacy/ch02.php
Page 1 of 1
CRICOS Provider No. 00103D
Warning: uncontrolled when printed.
Authorised by:
Director, Human Resources
Document owner:
Manager, HR Shared Services
Original Issue:
Current Version:
29/11/2013
24/07/2015