DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
OFFICIAL

POSITION DESCRIPTION
POSITION POSITION NUMBER
Lifeguard
CLASSIFICATION ANZSCO CODE
Band 3
DEPARTMENT DIVISION
Recreation Services Community Wellbeing
AGREEMENT LOCATION
Ballarat City Council Enterprise Agreement No. 8, Ballarat Aquatic Lifestyle Centre
2019

Position Objectives
To ensure safe use of the Aquatic Facilities overseen by supervising the total pool environment through
preventing, identifying and responding to emergency and/or first aid situations. The Life Guard must be a
person who can effectively communicate with patrons and user groups while providing exemplary customer
service.

Rotation of staff from time to time between pools will be required. Positions will have a primary location but
will be on occasions asked to work from other Council aquatic facilities.

Key Responsibility Areas

General
 Supervision of the total aquatic environment whilst on deck including;
- Positioning - regular patrolling circuits of each aquatic and dry area,
- Appearance - including appropriate protective clothing.
- Maintaining alert scan - appropriate and consistent surveillance of aquatic environments.
 Responding quickly and correctly to emergencies and first aid situations as they arise.
 Reporting emergency and first aid incidents appropriately and in accordance with council policies and
procedures.
 Complying with established procedures for safety, training and customer complaints.
 Maintaining a working knowledge and understanding of the aquatic operations
 Maintaining a working knowledge and understanding of the Facility Emergency Action Plan.
 Providing exceptional customer service at all times.
 Cleaning and general uptake of aquatic facility.
 Opening and closing procedures.
 Other duties as required.

From a Health & Safety perspective the City of Ballarat requires the following:

All Employees and Volunteers

 Report hazards, incidents, injuries and unsafe practices as soon as possible.
 Constructive participation in investigations and assistance in implementing corrective actions.
 Wear PPE and follow safe work procedures as directed.
 Constructively participate in monthly team meetings.
 Comply with the City of Ballarat safety system
 Participate constructively in all forums set up to investigate, improve or communicate safety.

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POSITION DESCRIPTION
REPORTS TO: DIRECT REPORTS:
Lifeguard Team Leader N/A
ORGANISATIONAL RELATIONSHIPS
Internal: External:
Sports and Active Living Team Community
Property and Facilities Management Team User groups including schools and community
groups

Accountability and Extent of Authority

 Responsible for the quality and timeliness of own work.
 Informing the public of specific procedures and practices.
 Acting and promoting established emergency response procedures and action plans.
 Before and whilst open, ensuring that the aquatic environment is safe and clean in accordance with
procedures.
 Testing the water quality and chemical levels and informing management when not within desired
limits.
 Promptly discussing and resolving problems with Life Guard team members, volunteers and pool user
groups as issues arise.

Judgement and Decision Making

 Day-to-day problems are to be solved in accordance with established policies and procedures.
 Undertake daily work tasks as per aquatic systems and procedures specific to site.
 Guidance is available from the Lifeguard Team Leader, Duty Manager or Aquatics Services
Coordinator in applying the systems and procedures.

Specialist Skills and Knowledge

 Knowledge and skill in current Life Guard practices.
 Understanding of documented aquatic facility procedures.
 Ability in identifying and reporting hazards in the aquatic environment in accordance with established
procedures.

Management Skills
 Ability to manage their own time and workload within set resources and timeframes.
 Understanding of and implementation of practices relating to health and safety of their own self,
volunteers, team members, participants and general community.

Interpersonal Skills
 Clear oral communication skills with team members, volunteers and general community.
 Ability to build rapport with general community and aquatic user groups.
 Provide regular communication including verbal and basic written reports to Lifeguard Team Leader.

Qualifications and Experience

 Recognised Life Guard Accreditation
 Recognised Level 2 First Aid.
 Current Working with Children Check

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POSITION DESCRIPTION
From a Health & Safety perspective the City of Ballarat requires all employees adhere to the following:

 Report hazards, incidents, injuries and unsafe practices as soon as possible.

 Constructive participation in investigations and assistance in implementing corrective actions.
 Wear PPE and follow safe work procedures as directed.
 Constructively participate in monthly team meetings.
 Comply with the City of Ballarat safety system.
 Participate constructively in all forums set up to investigate, improve or communicate safety.

PHYSICAL AND COGNITIVE ANALYSIS

Physical Demand Matrix

Overall Role Lifeguard

Body Posture NR R I O F C Comments

Standing  Constant requirement to stand whilst completing all listed tasks

Sitting  Sitting not required whilst completing listed tasks

Occasional requirement to reach whilst:
Horizontal reaching  Moving pool covers
with arms extended   Cleaning scum lines
> 30cm in a 180  Moving lane ropes
degree plane.  Coiling and uncoiling pool vacuum blue cord
 Assisting patron from pool
Neck
Constant movements of the neck in all directions required to scan the pool
flexion/extension/ro 
area to ensure the safety of all pool users and to complete all listed tasks
tation
Reaching above Intermittent requirement to reach to assist a patron from the pool via an

shoulder height aquatic rescue and connect the winch (50 meter pool)
Intermittent requirement when:
 Moving pool covers
Stooping & bending
 Cleaning scum lines
forward from 
 Moving lane ropes
standing position
 Lifting and lowering pool vacuum
 Assisting patron from pool
Intermittent requirement when:
 Moving pool covers
Kneeling / squatting   Cleaning scum lines
 Moving lane ropes
 Screwing/unscrewing disabled hoist screws
Constant trunk rotation required (left and right) whilst completing all tasks
Trunk rotation 
and to scan the pool area to ensure the safety of all pool users

Mobility NR R I O F C Comments
Climbing step /
 Intermittent requirement to climb a the grandstand for cleaning purposes
platform
Walking  Constant walking required whilst completing all tasks
Walking over Occasional walking over uneven surfaces required when working at the

uneven surfaces outdoor pools
Ladder climbing  Not Required

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POSITION DESCRIPTION
Manual
NR R I O F C Comments
Handling
Intermittent requirement to lift:
Unilateral lifting   Lane topes
 Aqua equipment
Intermittent requirement to carry the pool vacuum and patrons on the spinal
Bilateral carrying 
board
Lifting with weight
Intermittent requirement to lift the pool covers and lane ropes away from
away from body 
body.
<10kg
Lifting with weight
away from body  Intermittent requirement to lift the pool vacuum away from body.
>10kg
Lowering a vertical
distance > 25cm  Intermittent requirement when lowering manual pool vacuum into pool
from waist to floor
Lifting a vertical
distance > 25cm
 Not Required
from waist to
shoulder height
Intermittent requirement to lift:
 Lane ropes
Lifting 0kg - 4.5kg 
 Spinal board
 Pool scoop
Lifting 4.5kg - 9kg  Rare requirement to assist patrons out of the pool via an aquatic rescue
Lifting 9kg - 22kg  Intermittent requirement to lift Pool vacuum

Lifting 22kg - 45kg 

Rare requirement to potentially lift during an assisted rescue or medical
emergency.
Lifting 45kg+ 
Intermittent requirement to handle unstable:
Handling unstable   Patrons on spinal boards
objects  Pool cover
 Pool vacuum
Carrying  Intermittent requirement to carry items listed above
Intermittent requirement to push / pull which extends to:
 Pool cover trolley
 Pool cover winch
Pushing / pulling 
 Pool vacuum
 Pool covers
 Disabled hoist
Sustained/repetitive Intermittent requirement to sustain hand grip whilst completing all listed

hand grip tasks except observing patrons in pool
Tool use  Rare requirements to use lane rope tightener
Exposure to
 Not Required
vibration

NR = Not Required within this range of duties

R = Rarely (less than 1 x weekly)
Frequency scale for
I = Intermittently (1 x every 2.5 hours)
critical physical
O = Occasional (1 x every 30 minutes)
demands
F = Frequent (1 x every 2 minutes)
C = Constant (1 x every 15 seconds)

Psychosocial Demands

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POSITION DESCRIPTION

Concentration  High levels of concentration required while completing all listed tasks

Patience  Lifeguards are required to possess high levels of patience

Emotional
Personal
stability
 Lifeguards are required to have developed emotional stability whilst completing all tasks

Judgement  Lifeguards are required to exercise sound judgement whilst completing all aspects of the role

Reasoning  Lifeguards are required to exercise sound reasoning whilst completing all aspects of the role

Isolation - Lifeguards work as part of a team and as such are not exposed to isolation
Lifeguards are able to utilise autonomy with respect to the processes in which they complete a
Autonomy  task (whilst following safe work procedures), however have no autonomy with respect to the
work which is allocated to them by their Supervisor
Peer support is available whilst Lifeguards complete their designated duties. Peer support is
Social
Peer support  generally requested should the circumstances require it.
Social network  A social network is available for all Lifeguards through the City of Ballarat.
Production Lifeguards are required to complete jobs within specified deadlines (e.g., certain jobs needing
demands
 to be completed prior to Centre opening)
Lifeguards could be exposed to stressful situations particularly with respect to irate members of
Stress  the community, pool accidents and injuries to patrons.

SELECTION CRITERIA
 Qualifications and experience as listed above.
 Accreditation and experience in Life Guard duties.
 Understanding appropriate response and action to emergency and/or first aid incidents.
 Demonstrated understanding of reporting and responding to hazards and issues of safety in a
swimming pool environment.
 Current Working with Children Check
 Knowledge and understanding of health and safety issues relevant to work activities and work area.
 Availability to work to a Roster on a structured rotational basis

ACKNOWLEDGEMENT
Please sign and date to acknowledge you have read and understood this position description.
Fergus McCausland
Name: Signature: Date:

The City of Ballarat is committed to being a child safe organisation and has zero tolerance for child abuse
and harm. We are committed to providing an environment and culture that promotes the safety, health and
well-being of children and young people and which provides a voice to all children, including those from an
Aboriginal and Torres Strait Islander background, with disabilities and from culturally, religiously and
linguistically diverse backgrounds. We have policies, procedures and training in place that support our
employees, volunteers and contractors to achieve these commitments and to ensure all children are
listened to, their views respected, and their contribution recognised to ensure Council environments are
safe.

Lifeguard | Date approved September 2023 | Page 5

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Personal Details Form

PERSONAL DETAILS
Mr Ms Mx
Title Gender Female Male X
Miss Mrs
Date of birth

Family name

Given name/s

Preferred name

Country of Birth

Nationality Australian Citizen Yes No

Are you of Aboriginal and/or Torres Strait Islander
Yes No
origin?

CONTACT DETAILS

Telephone number Mobile

Residential address

Suburb Postcode
Postal address (if
different to residential)
Suburb Postcode

Email address

NEXT OF KIN

Family name
Given name/s
Relationship to you
Telephone number Mobile
Address
Suburb Postcode

OFFICIAL
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BANK ACCOUNT DETAILS

Primary account

Bank name

Branch location
Acct.
BSB no.
number
Account name

Additional account (optional)

Bank name

Branch location
Acct.
BSB no.
number
Account name

Deposit amount $

SERVICE AT ANOTHER VICTORIAN COUNCIL (if applicable)

Name of Council
Date of Service From: To:

LICENCE Please send a copy to [email protected]

Licence type Drivers Licence

Licence number

Issuing authority

Issue date: Expiry date:

Fergus McCausland
I, _________________, understand it is my responsibility to immediately notify People and Culture upon loss of
licence, charges laid or notification of impending action which may result in loss of licence.

Signed: ___________________________ Date: _________________

Licence type (Role specific

i.e., Forklift)
Licence number

Issuing authority

Issue date: Expiry date:

QUALIFICATION / CERTIFICATIONS Please send a copy to [email protected]

Qualification

Institution

Date completed

OFFICIAL
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SECURITY PHOTO PERMISSION

Fergus McCausland
I, __________________________ give permission to City of Ballarat to use a photo of myself, which I supply, to place
on my security access card and internal online phone lists.

Signed: ___________________________ Date: _________________

OFFICIAL
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Instructions and form for employers and employees

Superannuation (super)
standard choice form

WHEN TO USE THE FORM ABOUT THE FORM

The Standard choice form has three sections:
Employers n section A, which the employee completes by providing
Use this form to offer eligible employees their choice of super details of their choice of super fund, together with supporting
fund. You must fill in the details of your nominated super fund, documents.
also known as your default fund, before giving the form to n section B, which the employer completes by providing details
employees. of their nominated super fund (before they give the form to an
Give this form to an employee when: employee).
n you hire a new employee who is eligible to choose a n section C, which the employer completes to document the
super fund choice process for an employee.
n an existing eligible employee asks you for it Employers must retain the returned form as their record of
n you can no longer contribute to an employee’s nominated the choice process. Completed forms must be retained for
super fund or it is no longer a complying fund five years.
n you change your employer-nominated super fund and need
to advise employees affected by this change.
Superannuation reform changes – SuperStream
Employees SuperStream is a new standard for the way employers pay
Use this form to advise an employer of your choice of contributions and send information to super funds. This
super fund. form collects information that employers will need when
using SuperStream.
You must provide the required information so your employer
can make contributions to your nominated super fund.

NAT 13080‑08.2014
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SECTION A: EMPLOYEE TO COMPLETE Things you should know

If you choose your own super fund you will need to obtain n Your employer is not liable for the performance of the super
current information from your fund to complete items 3 or 4. fund you or they nominate
n You should not seek financial advice from your employer
Item 3 unless they are licensed to provide it
Nominating your APRA fund or RSA n Your employer is only required to accept one choice of
Complete this item if you are nominating your own APRA fund fund from you in a 12-month period; however, they may
(fund regulated by the Australian Prudential Regulation Authority) accept more
or a retirement savings account (RSA). n Your employer has two months after you return this form to
them to action your request
You must include the unique superannuation identifier (USI)
n Any money you have in existing funds will remain there unless
provided by your fund.
you arrange to transfer it (roll it over) to another fund – check
You must attach a letter from the fund trustee or RSA provider the impact of any exit fees you will incur or benefits you may
confirming that the fund or RSA: lose before leaving the fund (your employer cannot do this
n is a complying fund or RSA, and for you)
n will accept payments from your employer. n If you quote your TFN to your employer for super purposes,
they must provide it to the super fund
This letter may contain other information to help your employer
make super contributions using the SuperStream standard.
You may have lost super
n Itis important to keep track of your super – if you’ve ever
Item 4 changed your name, address or job, you may have lost track
Nominating your self-managed super fund (SMSF) of some of your super
Complete this item if you are nominating a self-managed n Having several super accounts could mean that fees and
super fund (SMSF). charges are reducing your overall super investment
You must include your SMSF’s ABN, bank account details n You can register for our online services and use SuperSeeker
and electronic service address (ESA) (so the fund can receive to check all your super accounts, find any lost or ATO-held
electronic messages and payments from your employer using super and transfer your super into one account using a simple
SuperStream). online form

 FIND OUT MORE  FIND OUT MORE

ato.gov.au/SMSFSuperStream – for information about n ato.gov.au/superseeker
how SuperStream applies to SMSFs n ato.gov.au/super – for information about super or
choosing a super fund
If you are using an SMSF message service provider they will n moneysmart.gov.au (on the Australian Securities &
provide you with an electronic service address alias to include Investment Commission [ASIC] website) – search for
as the ESA on the form. ‘choose super fund’ for tips on how to choose a fund

You must attach copies of the following documents to support

your SMSF choice:
n a document confirming that the fund is regulated – this can
be printed from superfundlookup.gov.au
n a letter from the trustee of the SMSF confirming that the fund
will accept payments from your employer – if you are the
trustee, or a director of the corporate trustee, you can confirm
acceptance by placing an ‘X’ in the relevant box on the form.

2 Superannuation (super) standard choice form

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SECTIONS B & C: EMPLOYER TO COMPLETE Things you should know

If an employee nominates their own super fund, they will provide n The quarterly* due dates for super contributions are:
information at section A that will assist you to prepare for, and – 28 October
make contributions to super funds using SuperStream. – 28 January
– 28 April
 FIND OUT MORE – 28 July
n If you have not received an employee’s completed form and
ato.gov.au/simplifyingSuperStream – for more
a super contribution is due, you must make the payment to
information on SuperStream.
your nominated fund by the due date
n In the two months after you receive an employee’s completed
form, you can pay their super contributions to either the fund
Section B you have nominated or the fund they have nominated
Complete section B before giving this form to your employee. n After the two-month period, you must make contribution
The super fund you nominate must be authorised to offer payments to the fund the employee has nominated
a MySuper product. If you need to confirm your MySuper n You do not have to action an employee’s fund nomination
arrangements contact your default super fund. if they have nominated a fund in the previous 12 months;
Sign and date this section on the day you give the form to your however, you may choose to action their request
employee.
 FIND OUT MORE
Section C
Complete section C after your employee returns this form to n phone 13 10 20 between 8am and 6pm, Monday to
you. Record the date you accept your employee’s choice of Friday, to speak to a tax officer
fund and the date that you act on the choice. Retain the form n phone our publications ordering service on 1300 720 092
with your records. Do not send the form to the ATO or to for copies of our publications
super funds. n write to us at
Australian Tax Office
PO Box 3578
 FIND OUT MORE Albury NSW 2640
n ato.gov.au/employersuper – for more information on
super, offering an employee a choice of fund or paying
super contributions
 HELP
n apra.gov.au/RSE – to find a super fund authorised to
offer a MySuper product n If you do not speak English well and want to talk to a tax
officer, phone the Translating and Interpreting Service on
13 14 50 for help with your call.
n If you have a hearing or speech impairment and have
access to appropriate TTY or modem equipment, phone
13 36 77. If you do not have access to TTY or modem
equipment, phone the Speech to Speech Relay Service
on 1300 555 727.

* You can pay contributions more regularly than quarterly. For example, some
employers pay fortnightly or monthly based on employee workplace agreements or
arrangements with super funds.

Superannuation (super) standard choice form3

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OUR COMMITMENT TO YOU

We are committed to providing you with accurate, consistent
and clear information to help you understand your rights and
entitlements and meet your obligations.
If you follow our information in this publication and it turns out
to be incorrect, or it is misleading and you make a mistake as
a result, we must still apply the law correctly. If that means you
owe us money, we must ask you to pay it but we will not charge
you a penalty. Also, if you acted reasonably and in good faith we
will not charge you interest.
If you make an honest mistake in trying to follow our information
in this publication and you owe us money as a result, we will
not charge you a penalty. However, we will ask you to pay
the money, and we may also charge you interest. If correcting
the mistake means we owe you money, we will pay it to you.
We will also pay you any interest you are entitled to.
If you feel that this publication does not fully cover your
circumstances, or you are unsure how it applies to you,
you can seek further assistance from us.
We regularly revise our publications to take account of any
changes to the law, so make sure that you have the latest
information. If you are unsure, you can check for more recent
information on our website at ato.gov.au or contact us.
This publication was current at August 2014.

© AUSTRALIAN TAXATION OFFICE FOR THE PUBLISHED BY

COMMONWEALTH OF AUSTRALIA, 2014
Australian Taxation Office
You are free to copy, adapt, modify, transmit and distribute this material as Canberra
you wish (but not in any way that suggests the ATO or the Commonwealth August 2014
endorses you or any of your services or products).
JS 31287
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Superannuation
Standard choice form

For use by employers when offering employees a choice of fund

and by employees to advise their employer of their chosen fund.

Section A: Employee to complete

1 Choice of superannuation (super) fund
I request that all my future super contributions be paid to: (place an X in one of the boxes below)

The APRA fund or retirement savings account (RSA) I nominate Complete items 2, 3 and 5

The self-managed super fund (SMSF) I nominate Complete items 2, 4 and 5

The super fund nominated by my employer (in section B) Complete items 2 and 5

2 Your details
Name

Employee identification number (if applicable)

Tax file number (TFN)

You do not have to quote your TFN but if you do not provide it, your contributions may be taxed at a higher rate.
Your TFN also helps you keep track of your super and allows you to make personal contributions to your fund.

3 Nominating your APRA fund or RSA

You will need current details from your APRA regulated fund or RSA to complete this item.
Fund ABN
Fund name

Fund address

Suburb/town State/territory Postcode

Fund phone

Unique superannuation identifier (USI)

Your account name (if applicable)

Your member number (if applicable)

Required documentation
You need to attach a letter from your fund stating that they are a complying fund and that they will accept contributions from
your employer. Correct information about your super fund is needed for your employer to pay super contributions.

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4 Nominating your self-managed super fund (SMSF)

You will need current details from your SMSF trustee to complete this item.
Fund ABN
Fund name

Fund address

Suburb/town State/territory Postcode

Fund phone
Fund electronic service address (ESA)

Fund bank account

BSB code (please include all six numbers) Account number

Required documentation
You need to attach a document confirming the SMSF is an ATO regulated super fund. You can locate and print a copy of
the compliance status for your SMSF by searching using the ABN or fund name in the Super Fund Lookup service at
http://superfundlookup.gov.au/
If you are the trustee, or a director of the corporate trustee you can confirm that your SMSF will accept contributions from
your employer by making the following declaration (place an ‘X’ in the box below):
I am the trustee, or a director of the corporate trustee of the SMSF and I declare that the SMSF will accept contributions
from my employer.
If you are not the trustee, or a director of the corporate trustee of the SMSF, then you must attach a letter from the trustee
confirming that the fund will accept contributions from your employer.

5 Signature and date

If you have nominated your own fund in Item 3 or 4, check that you have attached the required documentation and
then place an ‘X’ in the box below.

I have attached the relevant documentation.

Signature
Date
Day Month Year

Return the completed form to your employer as soon as possible.

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Section B: Employer to complete

You must complete this section before giving the form to an employee who is eligible to choose the super fund into which you
pay their super contributions.

Sign and date the form when you give it to your employee.

6 Your details
Business name

ABN
Signature
Date
Day Month Year

7 Your nominated super fund

If the employee does not choose their own super fund, you are required to pay super contributions on their behalf to the fund
that you have nominated below:

Super fund name Vision Super

Unique superannuation identifier (USI) 24496637884020

Phone (for the product disclosure statement for this fund) undefined

Super fund website address www.visionsuper.com.au

Section C: Employer to complete

Complete this section when your employee returns the form to you with section A completed.

8 Record of choice acceptance

In the two months after you receive the form from your employee you can make super contributions to either the fund you
nominated or the fund the employee nominated. After the two-month period you must make payments to the fund chosen
by the employee.

If you don’t meet your obligations, including paying your employee superannuation contributions to the correct fund,
you may face penalties.

Day Month Year Day Month Year

Date employee’s choice Date you act on your
is received employee’s choice

Employers must keep the completed form for their own record for five years. Do not send it to the Australian
Taxation Office, the employer’s nominated fund or the employee’s nominated fund.

PRIVACY STATEMENT
The ATO does not collect this information; we provide this form as a means for employees to identify and provide necessary
information to their employer. An employer is authorised to collect an employee’s TFN under the Superannuation Industry
(Supervision) Act 1993. It is not an offence for an employee not to quote their TFN. However, quoting a TFN reduces the
risk of administrative errors and if the employee does not quote their TFN their contributions may be taxed at a higher rate.
An employee can get more details regarding their privacy rights by contacting their superannuation fund.

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Instructions and form for taxpayers

Tax file number

declaration
Information you provide in this declaration will allow your payer to
work out how much tax to withhold from payments made to you.

This is not a TFN application form. You don’t need to complete this form if you:
To apply for a TFN, go to ato.gov.au/tfn ■■ are a beneficiary wanting to provide your tax file number
(TFN) to the trustee of a closely held trust. For more
information, visit ato.gov.au/trustsandtfnwithholding
Terms we use
■■ are receiving superannuation benefits from a super fund
When we say: and have been taken to have quoted your TFN to the
■■ payer, we mean the business or individual trustee of the super fund
making payments under the pay as you go ■■ want to claim the seniors and pensioners tax offset by
(PAYG) withholding system reducing the amount withheld from payments made
■■ payee, we mean the individual being paid. to you. You should complete a withholding declaration
form (NAT 3093)
■■ want to claim a zone, overseas forces or invalid and
invalid carer tax offset by reducing the amount withheld
from payments made to you. You should complete a
Who should complete this form? withholding declaration form (NAT 3093).
You should complete this form before you start to receive
payments from a new payer – for example: For more information about your entitlement,
■■ payments for work and services as an employee, visit ato.gov.au/taxoffsets
company director or office holder
■■ payments under return-to-work schemes, labour hire
arrangements or other specified payments
■■ benefit and compensation payments
■■ superannuation benefits.

You need to provide all information requested on this form.

Providing the wrong information may lead to incorrect
amounts of tax being withheld from payments made to you.

NAT 3092-06.2019
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

Section A: To be completed by Providing your TFN to your super fund

the payee Your payer must give your TFN to the super fund they pay your
contributions to. If your super fund doesn’t have your TFN, you
Question 1 can provide it to them separately. This ensures:
■■ your super fund can accept all types of contributions to your
What is your tax file number (TFN)? accounts
You should give your TFN to your employer only after you start ■■ additional tax will not be imposed on contributions as a result
work for them. Never give your TFN in a job application or over of failing to provide your TFN
the internet. ■■ you can trace different super accounts in your name.

We and your payer are authorised by the Taxation For more information about providing your TFN to your
Administration Act 1953 to request your TFN. It’s not an super fund, visit ato.gov.au/supereligibility
offence not to quote your TFN. However, quoting your
TFN reduces the risk of administrative errors and having
extra tax withheld. Your payer is required to withhold the Question 2–6
top rate of tax from all payments made to you if you do
not provide your TFN or claim an exemption from quoting Complete with your personal information.
your TFN.
Question 7
How do you find your TFN?
On what basis are you paid?
Check with your payer if you’re not sure.
You can find your TFN on any of the following:
■■ your income tax notice of assessment
■■ correspondence we send you Question 8
■■ a payment summary your payer issues to you. Are you an Australian resident for tax
If you have a tax agent, they may also be able to tell you. purposes or a working holiday maker?
If you still can’t find your TFN, you can: Generally, we consider you to be an Australian resident for tax
purposes if you:
■■ phone us on 13 28 61 between 8.00am and 6.00pm,
Monday to Friday. ■■ have always lived in Australia or you have come to Australia
and now live here permanently
If you phone or visit us, we need to know we are talking to ■■ are an overseas student doing a course that takes more than
the correct person before discussing your tax affairs. We will six months to complete
ask you for details only you, or your authorised representative,
■■ migrate to Australia and intend to reside here permanently.
would know.
If you go overseas temporarily and don’t set up a permanent
You don’t have a TFN home in another country, you may continue to be treated as an
Australian resident for tax purposes.
If you don’t have a TFN and want to provide a TFN to your
payer, you will need to apply for one. If you are in Australia on a working holiday visa (subclass 417)
or a work and holiday visa (subclass 462) you must place an X
For more information about applying for a TFN, visit in the working holiday maker box. Special rates of tax apply for
ato.gov.au/tfn working holiday makers.
You may be able to claim an exemption from quoting
your TFN. For more information about working holiday makers, visit
ato.gov.au/whm
Print X in the appropriate box if you:
■■ have lodged a TFN application form or made an enquiry to
obtain your TFN. You now have 28 days to provide your TFN If you’re not an Australian resident for tax purposes or a
to your payer, who must withhold at the standard rate during working holiday maker, place an X in the foreign resident box,
this time. After 28 days, if you haven’t given your TFN to unless you are in receipt of an Australian Government pension
your payer, they will withhold the top rate of tax from future or allowance.
payments
Temporary residents can claim super when leaving Australia,
■■ are claiming an exemption from quoting a TFN because you
if all requirements are met. For more information, visit
are under 18 years of age and do not earn enough to pay ato.gov.au/departaustralia
tax, or you are an applicant or recipient of certain pensions,
benefits or allowances from the:
–– Department of Human Services – however, you will need Foreign resident tax rates are different
to quote your TFN if you receive a Newstart, Youth or A higher rate of tax applies to a foreign resident’s taxable
sickness allowance, or an Austudy or parenting payment income and foreign residents are not entitled to a tax‑free
–– Department of Veterans’ Affairs – a service pension under threshold nor can they claim tax offsets to reduce
the Veterans’ Entitlement Act 1986 withholding, unless you are in receipt of an Australian
–– Military Rehabilitation and Compensation Commission. Government pension or allowance.

To check your Australian residency status for tax purposes

or for more information, visit ato.gov.au/residency

2 Tax file number declaration

DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

Question 9 Have you repaid your HELP, VSL, FS, SSL or

Do you want to claim the tax‑free threshold TSL debt?
from this payer? When you have repaid your HELP, VSL, FS, SSL or TSL debt,
you need to complete a Withholding declaration (NAT 3093)
The tax-free threshold is the amount of income you can earn notifying your payer of the change in your circumstances.
each financial year that is not taxed. By claiming the threshold,
you reduce the amount of tax that is withheld from your pay
during the year. Sign and date the declaration
Answer yes if you want to claim the tax‑free threshold, you are Make sure you have answered all the questions in
an Australian resident for tax purposes, and one of the following section A, then sign and date the declaration. Give
applies: your completed declaration to your payer to complete
■■ you are not currently claiming the tax‑free threshold from section B.
another payer
■■ you are currently claiming the tax‑free threshold from another
payer and your total income from all sources will be less than
the tax‑free threshold. Section B: To be completed by
Answer yes if you are a foreign resident in receipt of an the payer
Australian Government pension or allowance.
Answer no if none of the above applies or you are a working Important information for payers – see the reverse side of
holiday maker. the form.

If you receive any taxable government payments or Lodge online

allowances, such as Newstart, Youth Allowance or Payers can lodge TFN declaration reports online if you
Austudy payment, you are likely to be already claiming have software that complies with our specifications.
the tax‑free threshold from that payment.
For more information about lodging the TFN declaration
report online, visit ato.gov.au/lodgetfndeclaration
For more information about the current tax‑free threshold,
which payer you should claim it from, or how to vary your
withholding rate, visit ato.gov.au/taxfreethreshold

Question 10
Do you have a Higher Education Loan
Program (HELP), VET Student Loan
(VSL), Financial Supplement (FS), Student
Start‑up Loan (SSL) or Trade Support Loan
(TSL) debt?
Answer yes if you have a HELP, VSL, FS, SSL or TSL debt.
Answer no if you do not have a HELP, VSL, FS, SSL or
TSL debt, or you have repaid your debt in full.

You have a HELP debt if either:

■■ the Australian Government lent you money under
HECS‑HELP, FEE‑HELP, OS‑HELP, VET FEE‑HELP,
VET Student loans prior to 1 July 2019 or SA‑HELP.
■■ you have a debt from the previous Higher Education
Contribution Scheme (HECS).
You have a SSL debt if you have an ABSTUDY SSL debt.
You have a separate VSL debt that is not part of your
HELP debt if you incurred it from 1 July 2019.

For information about repaying your HELP, VSL, FS, SSL

or TSL debt, visit ato.gov.au/getloaninfo

Tax file number declaration3

DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

More information Phone

■■ Payee – for more information, phone 13 28 61 between
Internet 8.00am and 6.00pm, Monday to Friday. If you want to vary
■■ For general information about TFNs, tax and super in your rate of withholding, phone 1300 360 221 between
Australia, including how to deal with us online, visit our 8.00am and 6.00pm, Monday to Friday.
website at ato.gov.au ■■ Payer – for more information, phone 13 28 66 between
■■ For information about applying for a TFN on the web, 8.00am and 6.00pm, Monday to Friday.
visit our website at ato.gov.au/tfn If you phone, we need to know we’re talking to the right person
■■ For information about your super, visit our website at before we can discuss your tax affairs. We’ll ask for details only
ato.gov.au/checkyoursuper you, or someone you’ve authorised, would know. An authorised
contact is someone you’ve previously told us can act on
your behalf.
Useful products
If you do not speak English well and need help from the ATO,
In addition to this TFN declaration, you may also need to
phone the Translating and Interpreting Service on 13 14 50.
complete and give your payer the following forms which you
can download from our website at ato.gov.au: If you are deaf, or have a hearing or speech impairment, phone
■■ Medicare levy variation declaration (NAT 0929), if you qualify the ATO through the National Relay Service (NRS) on the
for a reduced rate of Medicare levy or are liable for the numbers listed below:
Medicare levy surcharge. You can vary the amount your ■■ TTY users – phone 13 36 77 and ask for the ATO
payer withholds from your payments. number you need (if you are calling from overseas,
■■ Standard choice form (NAT 13080) to choose a super fund phone +61 7 3815 7799)
for your employer to pay super contributions to. You can find ■■ Speak and Listen (speech‑to‑speech relay) users – phone
information about your current super accounts and transfer 1300 555 727 and ask for the ATO number you need (if you
any unnecessary super accounts through myGov after you are calling from overseas, phone +61 7 3815 8000)
have linked to the ATO. Temporary residents should visit ■■ Internet relay users – connect to the NRS on
ato.gov.au/departaustralia for more information about super. relayservice.gov.au and ask for the ATO number you need.
Other forms and publications are also available from our website If you would like further information about the
at ato.gov.au/onlineordering or by phoning 1300 720 092. National Relay Service, phone 1800 555 660
or email [email protected]

Privacy of information
Taxation law authorises the ATO to collect information and to
disclose it to other government agencies. For information about
your privacy, go to ato.gov.au/privacy

Our commitment to you © Australian Taxation Office for the

We are committed to providing you with accurate, consistent and clear
Commonwealth of Australia, 2019
information to help you understand your rights and entitlements and meet You are free to copy, adapt, modify, transmit and distribute this material as
your obligations. you wish (but not in any way that suggests the ATO or the Commonwealth
endorses you or any of your services or products).
If you follow our information in this publication and it turns out to be incorrect,
or it is misleading and you make a mistake as a result, we must still apply the law
correctly. If that means you owe us money, we must ask you to pay it but we will
not charge you a penalty. Also, if you acted reasonably and in good faith we will Published by
not charge you interest.
Australian Taxation Office
If you make an honest mistake in trying to follow our information in this publication Canberra
and you owe us money as a result, we will not charge you a penalty. However, we June 2019
will ask you to pay the money, and we may also charge you interest. If correcting
the mistake means we owe you money, we will pay it to you. We will also pay you DE-6078
any interest you are entitled to.

If you feel that this publication does not fully cover your circumstances, or you
are unsure how it applies to you, you can seek further assistance from us.

We regularly revise our publications to take account of any changes to the law,
so make sure that you have the latest information. If you are unsure, you can
check for more recent information on our website at ato.gov.au or contact us.

This publication was current at June 2019.

4 Tax file number declaration

 DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748
Tax file number declaration
This declaration is NOT an application for a tax file number.
■ Use a black or blue pen and print clearly in BLOCK LETTERS.
■ Print X in the appropriate boxes.
ato.gov.au ■ Read all the instructions including the privacy statement before you complete this declaration.

Section A: To be completed by the PAYEE 5 What is your primary e-mail address?

1 What is your tax
file number (TFN)?
OR I have made a separate application/enquiry to
For more the ATO for a new or existing TFN.
information, see
question 1 on page 2 OR I am claiming an exemption because I am under Day Month Year
of the instructions. 18 years of age and do not earn enough to pay tax.
6 What is your date of birth?
OR I am claiming an exemption because I am in
receipt of a pension, benefit or allowance. 7 On what basis are you paid? (select only one)
Full‑time Part‑time Labour Superannuation Casual
2 What is your name? Title: Mr Mrs Miss Ms employment employment hire or annuity employment
income stream
Surname or family name
8 Are you: (select only one)
An Australian resident A foreign resident A working
First given name for tax purposes for tax purposes OR holiday maker

9 Do you want to claim the tax‑free threshold from this payer?

Other given names Only claim the tax‑free threshold from one payer at a time, unless your total income from
all sources for the financial year will be less than the tax‑free threshold.
Answer no here if you are a foreign resident or working holiday
3 What is your home address in Australia? Yes No maker, except if you are a foreign resident in receipt of an
Australian Government pension or allowance.
10 Do you have a Higher Education Loan Program (HELP), VET Student
Loan (VSL), Financial Supplement (FS), Student Start‑up Loan (SSL) or
Trade Support Loan (TSL) debt?
Suburb/town/locality Your payer will withhold additional amounts to cover any compulsory
Yes repayment that may be raised on your notice of assessment. No

State/territory Postcode DECLARATION by payee: I declare that the information I have given is true and correct.
Signature
Date
Day Month Year
4 If you have changed your name since you last dealt with the ATO,
provide your previous family name. You MUST SIGN here

There are penalties for deliberately making a false or misleading statement.

Once section A is completed and signed, give it to your payer to complete section B.

Section B: To be completed by the PAYER (if you are not lodging online)
1 What is your Australian business number (ABN) or Branch number 5 What is your primary e-mail address?
withholding payer number? (if applicable)

2 If you don’t have an ABN or withholding

payer number, have you applied for one? Yes No
6 Who is your contact person?
3 What is your legal name or registered business name
(or your individual name if not in business)?

Business phone number

7 If you no longer make payments to this payee, print X in this box.

DECLARATION by payer: I declare that the information I have given is true and correct.
Signature of payer
4 What is your business address? Date
Day Month Year

There are penalties for deliberately making a false or misleading statement.

Suburb/town/locality
Return
 the completed original ATO copy to: IMPORTANT
State/territory Postcode Australian Taxation Office See next page for:
PO Box 9004 ■ payer obligations
PENRITH NSW 2740 ■ lodging online.

Sensitive (when completed)

30920619
NAT 3092-06.2019 [DE-6078]
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

Payer information Lodging the form

The following information will help you comply with your pay as You need to lodge TFN declarations with us within 14 days after
you go (PAYG) withholding obligations. the form is either signed by the payee or completed by you (if not
provided by the payee). You need to retain a copy of the form
for your records. For information about storage and disposal,
Is your employee entitled to work in Australia? see below.
It is a criminal offence to knowingly or recklessly allow You may lodge the information:
someone to work, or to refer someone for work, where
■■ online – lodge your TFN declaration reports using software that
that person is from overseas and is either in Australia
complies with our specifications. There is no need to complete
illegally or is working in breach of their visa conditions.
section B of each form as the payer information is supplied by
 eople or companies convicted of these offences may
P your software.
face fines and/or imprisonment. To avoid penalties, ■■ by paper – complete section B and send the original to us
ensure your prospective employee has a valid visa within 14 days.
to work in Australia before you employ them. For
more information and to check a visa holder’s status
For more information about lodging your
online, visit the Department of Home Affairs website at
TFN declaration report online, visit our website
homeaffairs.gov.au
at ato.gov.au/lodgetfndeclaration

Is your payee working under a working holiday

visa (subclass 417) or a work and holiday visa Provision of payee’s TFN to the payee’s super fund
(subclass 462)? If you make a super contribution for your payee, you need to give
your payee’s TFN to their super fund on the day of contribution, or if
Employers of workers under these two types of visa need
the payee has not yet quoted their TFN, within 14 days of receiving
to register with the ATO, see ato.gov.au/whmreg
this form from your payee.
For the tax table “working holiday maker” visit our website
at ato.gov.au/taxtables
Storing and disposing of TFN declarations
The TFN Rule issued under the Privacy Act 1988 requires a TFN
Payer obligations recipient to use secure methods when storing and disposing of
If you withhold amounts from payments, or are likely to withhold TFN information. You may store a paper copy of the signed form or
amounts, the payee may give you this form with section A electronic files of scanned forms. Scanned forms must be clear and
completed. A TFN declaration applies to payments made after the not altered in any way.
declaration is provided to you. The information provided on this form
If a payee:
is used to determine the amount of tax to be withheld from payments
■■ submits a new TFN declaration (NAT 3092), you must retain a
based on the PAYG withholding tax tables we publish. If the payee
gives you another declaration, it overrides any previous declarations. copy of the earlier form for the current and following financial year.
■■ has not received payments from you for 12 months, you must
retain a copy of the last completed form for the current and
Has your payee advised you that they have applied following financial year.
for a TFN, or enquired about their existing TFN?
Where the payee indicates at question 1 on this form that they have Penalties
applied for an individual TFN, or enquired about their existing TFN, You may incur a penalty if you do not:
they have 28 days to give you their TFN. You must withhold tax for
■■ lodge TFN declarations with us
28 days at the standard rate according to the PAYG withholding
■■ keep a copy of completed TFN declarations for your records
tax tables. After 28 days, if the payee has not given you their TFN,
you must then withhold the top rate of tax from future payments, ■■ provide the payee’s TFN to their super fund where the payee
unless we tell you not to. quoted their TFN to you.

If your payee has not given you a completed form

you must:
■■ notify us within 14 days of the start of the withholding obligation
by completing as much of the payee section of the form as you
can. Print ‘PAYER’ in the payee declaration and lodge the form –
see ‘Lodging the form’.
■■ withhold the top rate of tax from any payment to that payee.

For a full list of tax tables, visit our website at

ato.gov.au/taxtables
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

PERSONAL EMAIL ADDRESS

Please complete the following information if you are happy to receive payroll related information
including payslips and other corporate communication to your home email address.

If you do not have access to email, please contact the Payroll department on 53205688.

EMPLOYEE NAME: __________________________________________________

(PLEASE PRINT CLEARLY)

EMPLOYEE EMAIL: __________________________________________________

(PLEASE PRINT CLEARLY)

EMPLOYEE SIGNATURE: __________________________________________________

Your personal information is being collected by City of Ballarat for the purpose of setting you
up as an employee of City of Ballarat. Your information will be stored in Council’s Customer
Database and used to identify you when communicating with Council and for the delivery of
services and information. For further information on how your personal information is
handled, refer to Council’s Privacy Policy at www.ballarat.vic.gov.au
DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

Human Resources
HR09 Confidentiality Policy

HR 09/1
Confidentiality Agreement

This Agreement is made BETWEEN

The City of Ballarat (“the Council”) and ………………………………………….. (“the Officer”)

WHEREAS:

A. The Officer is employed by the Council.

B. By virtue of the Officer’s employment the Officer is privy to Confidential Information, as

defined in the HR09 Confidentiality Policy (Policy), as amended from time to time.

C. The Officer has agreed to enter into a confidentiality and nondisclosure agreement.

IT IS AGREED AS FOLLOWS:

1. The Officer acknowledges that as part of the Officer’s employment with the Council the
Officer is privy to Confidential Information.

2. The Officer agrees to only use Confidential Information for the purpose of undertaking the
Officer’s employment with the Council.

3. The Officer agrees to hold any Confidential Information in trust and confidence and not,
without the prior permission of the Council, disclose any Confidential Information to any
third party.

4. This Agreement shall be governed by the laws of the State of Victoria.

AGREED AND ACCEPTED BY:

…………………………………………………….(Signature)

______________________________________(Name of Officer) (Date)

DocuSign Envelope ID: 681E136D-DB80-4C41-ABA5-4EA1494AA748

INDIVIDUAL TALENT RELEASE

Name:

Signature:

Date:

I give Ballarat City Council permission to use and publish photographs/film/video tapes/electronic representations or
sound recordings of me and/or my child/ren/ ward (under the age of 18) in various locations. I acknowledge that
Ballarat City Council, its staff, volunteers, representatives and agents will use the image for City of Ballarat key
promotional activities, including but not limited to:
Official Visitor Guide
Annual Report
Event publications
Billboard advertising
Website
Council flyers and newsletters

I authorise the reproduction, sale, copyright, exhibit, broadcast, electronic storage and/or distribution of the
photographs/film/video tape/ electronic representation or sound recording at the discretion of Ballarat City Council
and waive any right to compensation I may have of any of the foregoing.

I release Ballarat City Council, its staff, volunteers, representative and agents for any loss or damage resulting from
the publication or misuse of any photographic image (including but not limited to theft, digital manipulation, or
distribution by any means) which I and/or my child/ren/ ward are featured.

Your personal information is being collected by City of Ballarat for the purpose of using your photograph for
employment and promotional purposes as stated on this form. Your information will be stored in Council’s Customer
Database and used to identify you when communicating with Council and for the delivery of services and information.
For further information on how your personal information is handled, refer to Council’s Privacy Policy at
www.ballarat.vic.gov.au