Onboarding Form First Name Middle Name Last Name Preferred Name If applicable Address Line 1 Address Line 2 Address - City Address - State Address - Country Australia Afghanistan Aland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua & Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bailiwick of Guernsey Bailiwick of Jersey Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo, Democratic Republic of Congo, Republic of Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Eswatini Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland Former Yugoslavia France French Guiana French Polynesia Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iraq Ireland Islamic Republic of Iran Isle of Man Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Democratic Peoples Republic of Korea, Republic of Kosovo Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libyan Arab Jamahiriya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russian Federation Rwanda Saint Barthélemy Saint Lucia Saint Martin Samoa San Marino Sao Tome & Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten Slovakia Slovenia Solomon Islands Somalia South Africa South Sudan Spain Sri Lanka St. Helena St. Kitts and Nevis St. Pierre & Miquelon St. Vincent & the Grenadines Sudan Suriname Sweden Switzerland Syrian Arab Republic Taiwan, ROC Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad & Tobago Tunisia Turkey Turkmenistan Turks & Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Virgin Islands Unknown/Other Uruguay USA Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Wallis & Futuna Islands Western Sahara Yemen Zaire Zambia Zimbabwe Address - Postcode Mobile Number Other Phone Number Email Address Date of Birth JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember<TODAY>MTWTFSS27282930311234567891011121314151617181920212223242526272812CLEAR DATE Gender Please select Male Female DVA File Number Service/PMKeys Number Tax File Number Current Employer (if applicable) Work history Brief description of work history providing rough dates, employer, role and why you separated. Enlistment Date JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember<TODAY>MTWTFSS27282930311234567891011121314151617181920212223242526272812CLEAR DATE If you do not know the exact date, then please enter first day of the relevant month. Discharge Date JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember<TODAY>MTWTFSS27282930311234567891011121314151617181920212223242526272812CLEAR DATE If applicable Service history - if multiple service dates. Discharge Method (if applicable) (Please select) Administrative Medical Voluntary Please provide details of separating medical conditions (if applicable). Operational Deployment Details Please provide details of any operational deployments - include rough dates, operation name (if known), and field of operations. Retiring Rank/Current Rank Retiring Role/Current Role Are you currently an active/inactive reservist? (Please select) Yes No If yes, what is your current reserve category? Bank Details - Bank Name Bank Details - Account Name Bank Details - BSB Number Bank Details - Account Number Are you currently receiving any DVA Benefits? Please provide details. Have you commenced any Common Law claims against the Commonwealth or any other party for your defence caused conditions? (Please Select) Yes No For example workers compensation claims. Are you currently receiving any Centrelink benefits? (Please Select) Yes No Are you currently receiving any Comcare benefits? (Please Select) Yes No Are you currently receiving any CSC/Milsuper/DFRDB benefits? (Please Select) Yes No If yes, type of pension (Class A, Class B, Class C)? Are you receiving any other benefits from any source (other than those above) relating to your defence caused injuries? Please provide full name and date of birth for each dependent child. Partner First Name (if applicable) Partner Last Name (if applicable) Partner Occupation (if applicable) Partner Date of Birth (if applicable) JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecember<TODAY>MTWTFSS27282930311234567891011121314151617181920212223242526272812CLEAR DATE GP - Salutation Mr. Mrs. Ms. Mx. Dr. Miss Hon. Rev. Rabbi Rep. Sen. Master Sir Lady GP - First Name GP - Last Name GP - Address Line 1 GP - Address Line 2 GP - Address City GP - Address State GP - Address Postcode GP - Phone Number GP - Email (if available)
