Beruflich Dokumente
Kultur Dokumente
1221
Please use a pen, and write neatly in English using BLOCK LETTERS.
Integrity of application
Family name
Given names
www.immi.gov.au
Date of birth
Place of birth
DAY
Home page
General
enquiry line
MONTH
YEAR
Suburb and
town/city
State/province/
region
Country
Sex
Relationship status
Male
Female
Married
Separated
Engaged
Divorced
De facto
Widowed
Never married or
been in a de facto
relationship
DAY
MONTH
YEAR
Date granted
10 Your current residential address (this is the place where you currently live)
Note: A post office box, migration agent address or mailbox address is
not acceptable as a residential address.
Unit/Apartment number
Address (include street number and name)
Suburb and
town/city
State/province/
region
Country
Postal code
Home
telephone
AREA CODE
) (
NUMBER
)
Mobile/cell
All email
addresses
POSTCODE
MONTH
YEAR
Date of issue
Date of expiry
Place of issue/
issuing authority
14 Do you currently have, or have you ever had, any national identity documents or numbers
(including birth registration numbers, social security cards etc)?
No
Yes
Give details
Country of issue
15 Have you ever had a visa refused or cancelled by, been refused entry to, or been deported from, any country?
No
Yes
Place where
visa was issued
MONTH
YEAR
DAY
MONTH
YEAR
MONTH
YEAR
Date of birth
Suburb and
town/city of
birth
Country of birth
from Australia
Yes
POSTCODE
Telephone number
COUNTRY CODE
(
AREA CODE
) (
NUMBER
)
DAY
MONTH
Employment commenced
Name of employer
Yes
Address of employer
POSTCODE
Contact telephone
COUNTRY CODE
(
AREA CODE
) (
Family name
Given names
Type of business
DAY
MONTH
YEAR
Date of birth
Occupation/Position
Suburb and
town/city of
birth
Country of birth
NUMBER
)
YEAR
YEAR
Date to
MONTH
YEAR
Type of business/
other activities
Your occupation/position/title/duties/
how you spent your time if unemployed
Yes
Date from
DAY
MONTH
YEAR
Date to
DAY
MONTH
YEAR
Country of service
Rank
Duties
Country of
deployment
Qualification
Main subjects or duties
Year of award
29 List all titles and describe any previous academic or research papers
you have had published
Qualification
Main subjects or duties
Year of award
Qualification
Main subjects or duties
Year of award
Go to Part I
Yes
Family name
Given names
Qualification
Nature of relationship to you
Telephone
number
AREA CODE
) (
NUMBER
Name of employer
Mobile
Address of employment
All email
addresses
POSTCODE
Name of employer
Proposed duties/activities
Address of employer
POSTCODE
Type of business
No
Yes
Occupation/Position
Duties
Go to Part J
Go to Part K
Go to Part L
Go to Part M
No
Yes
Give details
Give details
Name of course
Name of the institution
Type of course
Part M
Student/Academic/Researcher/Fellows
Name of course
Name of employer
Address of employer
POSTCODE
Type of business
Occupation/Position
Duties
Name of supervisor (if applicable)
Family name
Given names
Name of employer
Address of employer
POSTCODE
Type of business
Occupation/Position
Duties
44 Are there any other details you would like taken into consideration?
Question number
Additional information
Part P Declaration
WARNING: Giving false or misleading information is a serious offence.
46 I declare that:
the information I have supplied in this application is complete,
correct and up-to-date in every detail.
I have read and understood the information supplied to me.
I have read the information contained in form 1442i Privacy notice.
I understand the department may collect, use and disclose my
personal information (including biometric information and other
sensitive information) as outlined in form 1442i Privacy notice.
Signature of
applicant
DAY
MONTH
YEAR
Date