Activate Business Registration Form

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* 1. First Name

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* 2. Last Name

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* 3. Address

Address

Address 2

City/Town

State

Postal Code

Email Address

Phone Number

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* 4. Date of Birth

Date / Time

Date

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* 5. Gender

Male

Female

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* 6. Are you Aboriginal or Torres Strait Islander

Yes

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* 7. Are you currently at School? Please note school students are not eligible for this program.

Yes

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* 8. Are you currently employed?

Yes

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* 9. If you are employed, please indicate your employment type

Full-time

Part-time

Casual

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* 10. If you are employed, please indicate the number of hours of paid employment per week

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* 11. Please provide your job seeker ID if you have one and know it

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* 12. Are you registered with an employment service provider?

Yes

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* 13. If you are registered with an employment service provider, please indicate your provider

Madec

Sureway

yourtown

Other (please specify)

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* 14. What is the highest level of education you have completed?

Did not attend school

Year 9 or lower

Year 10

Year 11

Year 12/13

Trade/Certificate

University

Other (please specify)

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* 15. What was your main activity before registering for this project?

Working

Studying

Volunteering

Not actively seeking work

Running a business

Unemployed and looking for work less than 3 months

Unemployed and looking for work for 3-6 months

Unemployed and looking for work for 6-12 months

Unemployed and looking for work over for 12 months

Other (please specify)

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* 16. Do you have a

Business

Hobby Business

Business Idea

Please provide further information

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* 17. What are your reasons for wanting to be part of this program?

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* 18. How did you hear about the program?

Family member/friend

Employment service provider

Newspaper

Radio

Uni Hub Spencer Gulf

Business Port Pirie

Social media

Jobs Fair

Other (please specify)

Thank you for completing the Activate Business Registration Process. We will be in touch very soon to discuss the next steps!