Application for Northern Territory Government
Skilled Nominated (Subclass 190) visa and
Skilled Regional (Subclass 489) visa
Subclass 190 and 489 Nomination Application Form
(Please complete this form by type or block letters)
Please tick the box corresponding to the appropriate visa number below and answer all questions
in order for Migration NT to determine your eligibility for nomination
190
489
1. Northern Territory Nomination Eligibility
As a Northern Territory (NT) Skilled Nominated (SN) or Skilled Regional Nominated (SRN) visa
holder you and your family can live anywhere in the NT.
1.1 Eligibility for Northern Territory Government Nomination
Is your occupation on the NT Migration Occupation List?
A link to the NT skill shortage list can be found at
http://www.australiasnorthernterritory.com.au/Working/bsm/nt-nominatedgeneral/Pages/sol.aspx
Yes
No
Have you received an offer of employment in the NT?
Yes
No
Are you currently working in your nominated skilled occupation in the NT?
Yes
No
Are you able to provide strong evidence of employability in the NT in your
nominated occupation?
Yes
No
Do you or your spouse have family links in the NT?
Yes
No
Yes
No
Yes
No
If so, for how long?
Have you completed tertiary studies on a Charles Darwin University campus?
(If yes, please attach evidence)
What are your reasons for applying for NT nomination? Please detail.
1.2 Education (only complete this section if you have studied in Australia)
Have you ever studied in Australia?
(If yes, please provide details below)
Name of institution
Location of
campus
Course
undertaken
Award received
Date completed
Duration of course / degree
(State in terms of full-time or equivalent full-time study)
Department of Business
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
1.3 Australian skill assessment
Have you completed an Australian skills assessment?
Yes
(If yes, please complete the following details)
No
Name of assessing body
(Attach a copy of your assessment from the relevant Australian
Assessment Authority)
Date of assessment
What is the title of your nominated occupation?
What is the ANZSCO Code for your nominated occupation?
Refer to the Department of Immigration and Border Protection “Consolidated Skilled Occupation List”
available online at http://www.border.gov.au/Trav/Work/Work/Skills-assessment-and-assessingauthorities/skilled-occupations-lists/CSOL
2. Department of Immigration and Border Protection (DIBP) information
2.1 Visa information
Have you lodged an Expression of Interest (EOI) in SkillSelect?
Yes
http://www.border.gov.au/Trav/Work/Skil
No
If yes, what is the name / subclass of the visa applied for?
If yes, what is your SkillSelect EOI Number?
What is your DIBP points test score?
What is the name / subclass of your current visa
and when does it expire?
If you are on a bridging visa, what was the
subclass of your last substantive visa?
3. Personal and family details
3.1 Personal information
Title
Mr
Mrs
Ms
Miss
Other
Family name
Given name(s)
Date of birth
Age
Current
occupation
Country of birth
Country of
citizenship
3.2 Address
Street number
Street name
City / Town
Postal code
Country
Telephone
Work
Home
Mobile
Email address
Department of Business
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Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
3.3 Dependants
How many people are included in your application? (Please provide full family details below)
Relationship
Full name
Gender
Date of birth
(e.g. William Roberts)
(Male / Female)
(e.g. 1 March 1968)
(e.g. Husband, Spouse,
Daughter)
(If necessary, complete and attach a separate sheet)
4. Living in the Northern Territory
4.1 Where do you intend to live in the NT? (Please nominate a centre, town or area in the NT)
Alice Springs
Darwin
Katherine
Nhulunbuy
Tennant Creek
Other community area:
Other regional centre:
4.2 Why did you choose to live in this location? (Please provide details)
4.3 Contacts
Have you made contact with anyone in the location that you have identified?
(If yes, please provide name and details of contact. You may also wish to attach further
information regarding your contact with employers, for example, copies of emails,
outcomes of discussions)
Yes
Name and position
Organisation
Contact details
(e.g. John Smith / Manager)
(e.g. Alice Springs Council)
(e.g. Phone: 08 8950 1234)
No
(Please include all contacts you have had)
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Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
4.4 Friends or relatives in the Northern Territory
Do you have any friends or relatives in the NT?
(If yes, please indicate their relationship to you and where they live in the NT. Relatives
must be related by blood or marriage)
Full legal name
(e.g. Sally White)
Contact
number
Relationship to
yourself
(e.g. 08 8951
7777)
(e.g. Sister /
Friend)
Yes
No
Where they live in the
Northern Territory
(e.g. 123 Smith Street, City)
4.5 Friends or relatives in Australia
Do you have any friends or relatives elsewhere in Australia?
(If yes, please indicate their relationship to you and where they live. Relatives must be
related by blood or marriage)
Full legal name
(e.g. Sally White)
Contact
number
Relationship to
yourself
(e.g. 08 8951
7777)
(e.g. Sister /
Friend)
Yes
No
Where they live in Australia
(e.g. 123 Smith Street, City)
4.6 Relocation cost of living and financial resources (This information is only required from
applicants who are not currently living and working in the NT)
Have you researched the cost of living in the NT?
Cost of living include rental accommodation, electricity, food and transport – general
information can be found at http://www.australiasnorthernterritory.com.au
Yes
No
What will it cost you to relocate to the NT if your application is successful?
(Please quote all costs in Australian dollars)
4.7 Financial resources
Please estimate what financial resources (available monetary funds and assets) you will bring with
you if your application is successful? (Please provide a summary of all financial assets in Australian
dollars and attach evidence)
Department of Business
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Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
4.8 Employment
Have you received an offer of employment from a NT employer?
(If yes, please attach a copy of the offer of employment and provide details of a company
contact)
Contact name and position
Company
Yes
No
Contact information
5. Registration and licensing
5.1 Are you a member of any professional / trade association? (If yes, please
Yes
No
5.2 Do you need to be registered and / or licensed to work in your occupation in
Australia?
Yes
No
If so, are you licensed and / or registered?
Yes
No
If so, have you applied to be licensed and / or registered in Australia?
Yes
No
provide details)
6. Migration agent information (only complete if applicable)
Migration agency name
Migration agent name
Email address
Telephone
Postal address
7. Applicant’s signature
Signature
Department of Business
Date
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Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Declaration
I _______________________, hereby declare that the details provided within this application,
including supporting documents, are true and correct to the best of my knowledge and belief and I
undertake to inform the Northern Territory Government of any changes therein, immediately.
If information within this application, including supporting documents is found to be false, untrue,
misleading, or misrepresenting, I agree that the Northern Territory Government may forward any
evidence to the appropriate Commonwealth and/or State or Territory Government agencies for
further investigation.
If I have engaged a migration agent to represent me, I acknowledge that my application, including
supporting documents, has been provided with my full knowledge and consent.
Signature of Applicant:
Name of Applicant:
Information Privacy Principles
In accordance with the Northern Territory Information Privacy Principles:
I acknowledge that the collection of the personal information contained in my application is
necessary for the functions and activities of Migration NT;
I acknowledge that I am entitled to have reasonable access to the personal information
contained in my application after it has been lodged with Migration NT but that Migration NT
shall always be entitled to keep the documents provided;
I acknowledge that Migration NT is collecting my personal information in the application and
that it may be used for the following purposes:
o Consider the merits of my application;
o Verify the accuracy of the contents of my application (including through contacting
third parties regarding my application);
o Complying with relevant reporting requirements;
o Compiling statistics and undertaking research (or engaging a third party to compile
such statistics or research);
o Participating in surveys conducted by the Northern Territory Government and
national surveys; and
o Complying with its obligations to any other Commonwealth, State or Territory
government agency.
In carrying out this purpose I acknowledge and agree that Migration NT may disclose my
personal information (including sensitive personal information if any) to:
o governmental agencies within the Northern Territory Government;
o governmental agencies of other Australian States and Territories;
o Commonwealth Government agencies;
o governmental agencies throughout the world;
o skills assessment bodies and or professional associations;
o my employer and previous employers (and potential future employers); and
o any other person or entity to which I have referred in my application,
(Third Parties)
I acknowledge that if I do not sign this document or do not provide the required personal
information in my application, Migration NT may reject my application.
Department of Business
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Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
I authorise the Northern Territory Government (through Migration NT) to:
use the information provided in this application to make necessary inquiries with any
person, association, business or governmental agency to verify claims provided in the
application in order to establish identity, qualifications, experience and residency and
authenticate documentation
retain my application and supporting documents in accordance with Northern Territory
Government policies and standards
share the information provided with the Third Parties described above
utilise the information contained in my application and supporting documents to undertake
research and inform surveys
Signature of Applicant:
Name of Applicant:
Lodgement of applications
Applications for Northern Territory Government nomination should be forwarded by email to:
migration@nt.gov.au
Contact details
For further information about our programs contact:
Migration NT
Outside Australia: (+61) 8 8999 5264
Inside Australia: 1800 006 282
Email: migration@nt.gov.au
Department of Business
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Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Northern Territory Government Nomination Checklist for Visa Subclasses 190 and 489
Completed NT Government nomination application form
Evidence of SkillSelect EOI number issued by DIBP SkillSelect System
http://www.border.gov.au/Trav/Work/Skil
Copy of main applicant’s current detailed curriculum vitae / resume
Evidence of previous employment, including recent work experience related to the skilled
occupation that has been nominated
Certified copies of main applicant’s qualification / skill certificates and academic
transcripts
Certified copies of the ID pages from main applicant’s passport and any dependent family
members’ passports (if in Australia also include evidence of current visa status)
Certified copy of the skills assessment for main applicants nominated occupation from
the relevant Australian Assessment Authority
Copy of results from a recent IELTS or equivalent English language test for main
applicant as evidence of English language proficiency
* Evidence of financial capacity / net assets to settle in the NT – please provide evidence
together with a summary of all financial assets in Australian dollars (e.g. certified
copies of bank statements, share certificates, property / insurance valuations etc.)
* Evidence that the applicant has undertaken research on the NT and has knowledge of
the relocation costs, living expenses (e.g. food, utilities, rent, etc.), and accommodation
costs involved with settling in the NT (This evidence should include a narrative explaining
your reasons for wanting to migrate to the NT. Extracts from websites that are copied and
pasted into your submission will not be accepted)
* Persuasive evidence to demonstrate employability in the NT in the nominated
occupation or a copy of the letter of offer or employment contact if a NT employer has
offered employment to the main applicant in their nominated occupation or closely related
occupation
If presently on a SC457, you will be required to provide a letter from your employer
stating that:
they are aware that you are applying for the SC190 or SC489 visa and
they understand that when the this visa is granted you have no ties to their
business and
they support your application.
Signed all three (3) signature clauses
* This information is not required from applicants who are already living and working in the NT.
Please note that failure to supply a completed application at time of submission will result in your
application being unsuccessful as it is incomplete.
Please note that this information may be aggregated to produce statistical information and for
departmental purposes. These statistics do not identify individuals or their personal circumstances.
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