Employee Information Form

Employee Information Form

This form can be used upon commencement of employment or at any time details are changed.
Personal Details
Name

PrefixFirst NameMiddle NameLast Name
Preferred Name
Date of Birth

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Gender
Contact No
Please enter a valid phone number.Format: (000) 000-0000.
Are you of Aboriginal or Torres Strait Islander origin?
Street Address

Street Address

Suburb
CityState / ProvincePostal / Zip Code
Postal Address

Street Address

Street Address Line 2
CityState / ProvincePostal / Zip Code

Payslip & Focus Self-Service Portal

Payslips are provided electronically to your personal email address. The email address and password below will be used to distribute and access the payslip. Additionally, the password will be used to access the Focus Self-Service portal.
Personal Email Address
example@example.com

Payroll and Banking Details
Main Account

Please confirm bank account details for the electronic transfer of wages.Where applicable, after processing any additional account disbursements below, the balance is paid into this account.
Name of Account Holder
Bank
Branch
BSB
Account number
Optional - Additional Account

I authorise the Fixed Amount below to be disbursed into this Account.
Name of Account Holder
Bank
Branch
BSB
Account number
Amount (fortnightly)

Superannuation Details
Employee Nominated Fund
Full Name of Fund
Fund Phone No
Please enter a valid phone number.Format: (000) 000-0000.
Your Member No
Fund ABN
Product No [SPIN]
OR Employer Default Fund

Alternatively, Employees can elect for Employer Superannuation contributions to be made into the Employer’s default fund
Elect to join Employer Default Fund - Care Super
Care Super

Website: www.caresuper.com.au | Phone: 1800 005 166 | USI: MTA0100AU

Optional - Additional Superannuation Fund Contribution

BEFORE TAX – Contributions are deemed Salary Sacrifice and Government Co-contributions do NOT apply. AFTER TAX – Contributions are deemed Employee Contributions and may attract Government Co-contribution entitlements
Deduct Additional Superannuation?
Amount

Optional - Additional Tax Deduction

Staff can deduct additional amounts of Taxation from gross income. Please indicate below.
Deduct Additional Taxation?
Amount

PKMC Social Club deduction - Para Hills, Barossa Valley, Clare Valley & Port Lincoln Only

Health and Declaration
Do you have any disabilities, injuries, illnesses or allergies that may affect your work?
If yes, please specify
Employee Name

First NameMiddle NameLast Name
Signature
Date

DayMonthYear
2 digit day, 2 digit month, 4 digit yearDate
Should be Empty:

Personal Details