Registration as a Consultant and/or Associate

Name *

First

Last

Date of Birth//

Address

Address Line 1

City

State / Province / Region

Postal Code

Country

Mobile *

Landline Phone

Email *

Skype/Zoom/MS Teams address

Have you previously worked in Local Government? *

Are you an Australian Citizen

ABN

As a legal requirement, all Consultants and Associates must have a registered Australian Business Number (ABN)

Are you registered for GST?

Photo

Click or drag a file to this area to upload.

Please insert a portrait (head & shoulders only) photo here (No more than 300kb in size)

TERTIARY QUALIFICATIONS

IMPORTANT NOTE: Please post in chronological order with the latest qualification first. Originals of results (transcripts) and/or qualifications will need to be provided prior to commencing in the role. We also do qualification checks through CV Check Pty Ltd.

Qualification 1 (Award Granted)

Tertiary Institution

Date of Award//

Qualification 2 (Award Granted)

Tertiary Institution 2

Date of Award 2//

Qualification 3 (Award Granted)

Tertiary Institution 3

Date of Award 3//

Qualification 4 (Award Granted)

Tertiary Institution 4

Date of Award 4//

Other relevant training and detail

Please list other skills, training, education or experience of relevance:

DETAILS

Do you have any past or current medical condition/s which may affect your ability to perform the preferred roles you have nominated in this form, or which may be aggravated or worsened by the duties of the preferred roles? *

Considering the preferred roles you have nominated, will you require any adjustments to be made to perform the duties of the preferred roles? *

In case of an emergency

Next of Kin Name *

Relationship

Next of Kin Address

Address Line 1

Address Line 2

City

State / Province / Region

Postal Code

Country

Net of Kin Mobile Number *

Next of Kin Home Phone

Upload your CV

Click or drag a file to this area to upload.

APPLICANT STATEMENT - I have completed my application in good faith, honestly and completely, providing all information requested and/or associated with my application. *

1. I hereby permit Mason Blackadder Pty Ltd to disclose my work-related particulars to prospective clients.
2. I hereby permit Mason Blackadder Pty Ltd to contact my referees in order to verify information provided by me for work performance and disclose these details to prospective clients.
3. I hereby permit Mason Blackadder Pty Ltd to verify information provided by me for screening or reference checking purposes and to conduct enquiries as may be necessary, at the Company’s discretion.
4. I hereby declare that I am not receiving any payment/treatment associated with any existing workers’ compensation claim.
5. I understand and declare that while engaged in a consultancy project through Mason Blackadder Pty Ltd or following completion of a consultancy, any offer or further temporary work.
by the relevant client will be directed to Mason Blackadder Pty Ltd as soon as possible so the engagement can be through Mason Blackadder Pty Ltd as having introduced the to the client.
6. I hereby declare that the information contained in this application is true and correct and understand that any misrepresentation of facts in my application could be cause for termination of the registration with Mason Blackadder Pty Ltd.
7. I understand that Mason Blackadder Pty Ltd to will negotiate with the client on the responsibilities, remuneration and conditions of consultancy in consultation with me.

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