BACK TO WORK SCHEME
DECLARATION BY ELIGIBLE EMPLOYER
I CERTIFY THAT:

On <<……insert date……>> , <<……insert eligible employee name……>> commenced employment with
<<……insert eligible employer name……>>

I am satisfied that he/she falls into the following category of eligible employee1 (select one category only) :
Eligible employee category
Eligible employee category
Young unemployed
Current or recent youth justice client
Long-term unemployed
Disability pensioner
Out-of-trade apprentice
Member of a drought-affected farm
household
Retrenched worker
Refugee
Retrenched automotive worker
Social housing tenant
Aboriginal and/or Torres Strait Islander
Sole parent pensioner
Apprentice/trainee
Young person in or exiting out of home
Current or recent criminal justice client

I am satisfied that << insert eligible employer name>> will keep all records that are necessary for five years
and will provide them to the Commissioner of State Revenue on request.

I understand that penalties may apply for providing false or misleading information.
Signature of eligible employer
or duly authorised representative
Name
Position (if applicable)
1
care
See definitions overleaf.
Date of declaration
BACK TO WORK SCHEME
DECLARATION BY ELIGIBLE EMPLOYER
Eligible employees must be unemployed prior to commencing work. A person is an eligible employee if they fall into one of the following categories and commenced
employment with the eligible employer in the relevant date range.
ELIGIBLE
EMPLOYEE CATEGORY
Young unemployed
Long-term unemployed
REQUIREMENTS
EMPLOYMENT START DATE
A person is a young unemployed person if they:
- are aged 15 to 25 years (inclusive) at the time they commence employment
- were unemployed for a continuous period of at least 3 months prior to commencing employment, and
- were actively looking for full-time or part-time work during that period.
1 Apr 2015 to 31 Mar 2017
The requirements of this category differ depending on whether the employee commenced work before or
on or after 1 November 2015.
1 Apr 2015 to 31 Mar 2017
If the person commenced work between 1 April 2015 and 31 October 2015, they will meet the
requirements if they were:
- unemployed for a continuous period of at least 52 weeks prior to commencing employment, and
- actively looking for full-time or part-time work during that period.
If the person commenced work on or after 1 November 2015, they will meet the requirements if they
were:
- unemployed for a continuous period of at least 26 weeks prior to commencing employment, and
- actively looking for full-time or part-time work during that period.
Retrenched worker
Retrenched automotive
worker
A person is a retrenched worker if they lost their last job because it was made redundant (i.e. their job was
no longer needed) or their employer became insolvent or bankrupt.
A person is a retrenched automotive worker if they lost their last job in Victoria because it was made
redundant (i.e. their job was no longer needed) or their employer became insolvent or bankrupt and their
employer was in the automotive industry.
The automotive industry includes a business that had been in operation in Victoria before May 2013 in one
or more of the following categories:





Motor vehicle producer,
Producer of automotive components,
Producer of automotive machine tools or automotive tooling,
Materials supplier (e.g. a supplier of plastics, metals, or oils) to original equipment motor vehicle
producers, or
Provider of automotive services to original equipment motor vehicle producers
1 Apr 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017*
*Claims for employees hired
between 1 Apr 2015 and 31
Oct 2015 can be made under
the retrenched worker
category
BACK TO WORK SCHEME
DECLARATION BY ELIGIBLE EMPLOYER
A motor vehicle producer is a producer of motor vehicles that have a gross vehicle weight of not more
than 3.5 tonnes.
An automotive component producer is a producer of at least one kind of automotive component to the
original equipment sector. Automotive components do not include a component that is not purpose-built
for automotive use (e.g. a fastener or electrical device in general use).
A materials supplier is a person who supplies materials to the automotive industry that are directly related
to the production of motor vehicles (e.g. plastics, metals, oils).
An automotive machine tool or automotive tooling producer is a producer of automotive machine tools or
automotive tooling of a kind that are designed and built to be used solely for the production of motor
vehicles, engines, engine components or automotive components.
Out-of-trade apprentice
Aboriginal and/or Torres
Strait Islander
Apprentice and trainee
Current youth justice
client
A provider of automotive services includes a business that provides design, development or engineering
services to the automotive industry.
An out-of-trade apprentice is a retrenched worker who has had their training contract in an approved
training scheme cancelled by their employer because of a lack of work. If a new eligible employer hires
the out-of-trade apprentice to resume and complete their apprenticeship, the new employer may be eligible
for a Back to Work payment.
An Aboriginal or Torres Strait Islander is:
 A person of Aboriginal or Torres Strait Islander descent,
 Who identifies as being of Aboriginal or Torres Strait Islander origin, and
 Who is accepted as such by the community with which the person associates
A person is an apprentice or trainee for the purposes of the Back to Work Scheme if they were:
- unemployed prior to commencing employment, and
- hired to undertake an apprenticeship or traineeship through a training contract in an approved training
scheme.
A person is a current youth justice client if at the time of commencing employment they are supervised by
Youth Justice on a relevant court order.
A relevant court order is a:
- Deferral of Sentence or Supervised Bail Order (supervised by Youth Justice from the Children’s Court or
Adult Courts)
- Probation Order
- Youth Supervision Order
- Youth Attendance Order
1 Apr 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
BACK TO WORK SCHEME
DECLARATION BY ELIGIBLE EMPLOYER
Recent youth justice client
Current criminal justice
client
Recent criminal justice
client
Disability pensioner
Member of a droughtaffected farm household
A person is a recent youth justice client if, within the last 12 months, they:
- exited from a Youth Justice Centre on temporary leave or a Youth Parole Order,
- were released on remission,
- were released after a short sentence, or
- were released after a period of remand
A person is a current criminal justice client if at the time of commencing employment they are supervised
by Corrections Victoria under a community correction order (including those with supervision or
community work conditions).
A person is a recent criminal justice client if, within the last 12 months, they exited an adult prison, either:
 on a parole order, or
 after completing their sentence, or
 after a period of remand
A disability pensioner is a person in receipt of the Disability Support Pension at the time of commencing
employment.
A person is a member of a drought-affected farm household if their home address is a farm property in
north-west Victoria at the time of commencing employment with the eligible employer, or their home
address was a farm property in north-west Victoria immediately before commencing employment with the
eligible employer.
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
Note: The farm property itself (or a business owned or run by that farm) is not eligible to hire the
employee.
North-west Victoria means the area within the shires of Buloke, Yarriambiak, Loddon, Northern
Grampians, Horsham, Hindmarsh, Ganawarra, Pyrenees, Central Goldfields, and West Wimmera.
Refugee
A refugee is a person who at the time of commencing employment is:



Social housing tenant
1 Nov 2015 to 31 Mar 2017
a current holder of a visa under the Australian Government’s refugee and humanitarian program,
or
is currently listed on that visa under the "split family provisions", and
the visa was first granted up to five years before commencing employment with the eligible
employer
Note: the holder of a bridging visa, who has applied for a visa under the refugee and humanitarian
program, is considered part of the refugee and humanitarian program for the purposes of the BTW scheme
where the bridging visa enables the holder to work in Australia.
A person is a social housing tenant if at the time of commencing employment they are:
- a tenant of public housing or community housing, or
- a person of working age living in that household.
Public housing is long term housing owned and managed by the Director of Housing. Community housing
1 Nov 2015 to 31 Mar 2017
BACK TO WORK SCHEME
DECLARATION BY ELIGIBLE EMPLOYER
Sole parent pensioner
Young person in out of
home care
Young person exiting out
of home care
is housing owned and/or managed by a registered not-for-profit housing agency.
A sole parent pensioner is a person in receipt of the Parenting Payment Single payment at the time of
commencing employment.
A person is a young person in out of home care if at the time of commencing employment they are:
- under 18 years of age, and
- in the care of the Secretary of the Department of Health and Human Services
A person is a young person exiting of home care if, within the last 12 months, the person:
- Left the care of the Secretary of the Department of Health and Human Services
- On leaving the care, the person:
o was of an age to live independently (i.e. over 16 years of age), or
o intended to live independently.
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017
1 Nov 2015 to 31 Mar 2017