NTWWC Enquiry Form

NT Working Women's Centre Enquiry Form
We appreciate that your situation is important.

Tell us some details about your workplace issue so we can assist you. Any details you provide will be kept confidential. We will at no point contact your employer without your permission. When we receive your form, we will contact you as soon as possible.

Questions marked * require a response.
Your Contact Details
Name

First NameLast Name
What is the best phone number to contact you on?*
What is your personal email address?*
What is your residential post code?*
Personal Details

Tell us a bit more about yourself
Date of Birth*

DayMonthYear
Please enter numerical date format, shown above eg: 16th April 1974 would be 16-04-1974 or select the date by clicking the calendar icon
What pronouns do you identify yourself with?
eg: she/her/hers
Gender: How do you identify?*

FemaleMaleGenderqueer/Non-Binary
Do you identify as any of the following?*

AboriginalTorres Strait IslanderNeither
Are you on a Visa?*

YesNo
Are you from a..?*

Non-English-Speaking BackgroundEnglish-Speaking Background
Do you identify as having a disability, including any mental health conditions such as depression or anxiety?

YesNo
Workplace Details
Where do you work?*
What is your position within your workplace?
eg: Cleaner, Hairdresser, Childcare Worker
How long have you worked at this workplace?*
The date you started OR months/years of employment
What is/was your employment status?*

Full TimePart TimeCasualFixed Term ContractIndependent Contractor
Are you still employed at this workplace/company/organisation?

YesNoUnsure
What is your hourly rate of pay or rough annual salary?
Do you know the relevant award or enterprise agreement governing your employment?

YesNoUnsure
Are you a union member?*

YesNoUnsure
To find out more about your relevant union visit: www.actu.org.au
What is happening at work that you would like assistance with?
eg: I am being bullied, sexually harassed, discriminated against, unfairly treated.
Please let us know of any deadlines
eg: Do you have a meeting with your boss coming up, have to respond to a letter or make an application by a certain date?
How did you find our service?

Fair Work OmbudsmanA FriendGoogle / Online SearchReferred from another ServiceUsed the NTWWC beforeOther
Please specify which Service referred you
Should be Empty:

Your Contact Details

Personal Details

Workplace Details