• Additional Employer Declaration Form

    This form should be completed where the employee has disclosed employment with an additional employer, whether on a permanent, temporary, casual, self-employed, or voluntary basis. It is the employee's responsibility to update the company with any changes to their work arrangements with any other employers so that the company can ensure safe working. Where necessary, the company may request evidence of working arrangements, including any rosters or contractual documentation. If your total working time across all employers and work commitments is likely to exceed an average of 48hours per week, you may be required to sign a Working Time Regulations Opt-Out Agreement.

  • Your Details

  • Employment Status

    Please select:

  • Additional Employer 1

  • Contractual Arrangements

  • Additional Employer 2

  • Contractual Arrangements

  • Additional Employer 3

  • Contractual arrangements

  • Employee Declaration

  • I declare that the information provided on this form is accurate and complete to the best of my knowledge.

    I understand that it is my responsibility to inform the company immediately of any changes to my additional employment, including changes to hours worked, duties performed, employer, or working arrangements.

    I understand that the company may request evidence of my working arrangements, including work schedules, rosters, timesheets, or contractual documentation where necessary to assess health and safety, working time, or conflict of interest considerations.

  • Employee Declaration - Date
     - -

  • Upon receipt, a copy should be saved to the staff file and the Branch should consider:
    • Any conflict of interest arising from any additional employer(s)
    • Any necessary risk assessments
    • Any necessary modifications to working arrangements to accommodate safe working

  • Should be Empty: