Next Page Current Page Show Additional PagesPlease select... No Yes Page ID Contact ID Case ID Assessment ID Case : Assessment ID First Name Last Name Date of birth (dd/mm/yyyy) Job Seeker ID (JSID) Mobile Postcode Email Suburb Which best describes you?Please select... I currently own a business I want to start a business What is your ABN Number? When did you launch your business? What is your business structure?Please select... None Sole Trader Partnership Company What support are you looking for?Please select... Getting more customers Growing your business Finance & Money Business operations Everything Other Does your business contain less than 4 employees not including yourself?Please select... Yes No Your business is not currently trading or is at risk of ceasing trading within the next 12 monthsPlease select... Yes No Will you be able to provide evidence to support your previous answer? These could include but not limited to: Bank StatementPlease select... None Yes No Profit and Loss statementPlease select... None Yes No Balance SheetPlease select... None Yes No Income StatementPlease select... None Yes No New Business DescriptionPlease select... I would like to start a business and have a business idea I would like to start a business but don’t have a business idea Page 2 In a few words, can you tell us about your business idea, and what products or services will your business offer. Please also talk about how your customers will be able to purchase your product or service, (eg online, store front) Who will be your customers? Please also talk about any specific demographics, consumer behaviours or interests Do you have any experience or qualifications relating to this product or service? Please talk about any licences/qualifications you may have, or any that are required for your new business. Have you researched your competitors and if so, what did you find? Please also talk about how your product/service may be different to your competitors. How will you fund your business? Please let us know if you will need to purchase any equipment, if there will be any set up costs Please tell us if you have any specific needs you would require our help with? In a few words, can you tell us about your business, and what products or services you offer. Please also talk about how your customers purchase your product or service, (eg online, store front) Who are your customers? Please also talk about any specific demographics, consumer behaviours or interests What type of help are you looking for? (you can choose more than one option)Please select... Marketing Operations Finance Other Please tell us what marketing help you need? Please tell us what operational help you need? Please tell us what financial help you need? Please tell us what help you’re looking for? Page 3 Participant Eligibility Have you participated in Self-Employment Assistance, including Small Business Coaching before?Please select... Yes No When did you last finish participating? (mm/yyyy) Are you available to participate in small business training?Please select... Yes No If accepted for small business training, please specify any special training requirements (Note: You don’t have to answer this question. We ask this to determine the level of service you may need from your Provider) Are you an undischarged bankrupt? (Note: bankruptcy is usually discharged after three years. You can contact the Australian Financial Security Authority for more information) Are you: an overseas visitor on a working holidayPlease select... Yes No an overseas student studying in Australia?Please select... Yes No legally able to work in Australia?Please select... Yes No Business Eligibility Do you have any business partners?Please select... Yes No Provide full names of any proposed business partners also applying for Self-Employment Assistance Provide full names of any proposed business partners not applying for Self-Employment Assistance. (Note: Please ensure you have notified proposed business partners that you will be providing their information to your Provider.) Have you ever operated this business on a commercial basis?Please select... Yes No Will your business be established, located and operated solely within Australia?Please select... Yes No Will your business comply with all relevant laws and regulations, including Commonwealth, state, territory or local authority requirements?Please select... Yes No Will you have a controlling interest in your business while participating in Self-Employment Assistance?Please select... Yes No Will you work in your business on a full‑time basis? number of hours required to satisfy your Mutual (Note: full-time means 35 hours per week or the required to satisfy your MutualObligation Requirements)?Please select... Yes No Would you work part-time in your business due to any of the following?- Part‑time/casual- Employment- Part-time- Studies- Caring- Responsibilities- Capacity to work due to medical condition/sPlease select... Yes No Page 4 Tell us a bit more about your personal details GenderPlease select... Female Male Other Country of birth Is English your first language?Please select... Yes No What is your first language? Do you require access to an interpreter?Please select... Yes No Are you known by any other names? (For example, a maiden name, previous married name Indigenous or community name. Your contact details Postal Address Number and street/PO Box Suburb or town Postcode State or Territory Is your residential same as the postal Address?YesNo Residential Address Number and street/PO Box Suburb or town Postcode State or Territory Best contact methodPlease select... Choice A Choice B Choice C Home telephone number Work telephone number Mobile telephone number Email address Income support Do you receive a payment from Services Australia?Please select... Yes No Please provide the name of the payment. (Your provider will confirm the type of payment with Services Australia) Personal circumstances Are you an Australian citizen or permanent resident?Please select... Yes No Are you a visa holder?Please select... Yes No Please provide details about your visa and work rights Are you an overseas visitor to Australia, or here on a working holiday?Please select... Yes No Are you of Aboriginal or Torres Strait Islander origin?Please select... No Yes, Aboriginal Did not answer Yes, Torres Strait Islander Are you currently working 15 hours or more per week?Please select... Yes No Subsection: working 15 hours or more per week Are you in full-time Education or training?Please select... Yes No Questions for retrenched workers and their partners Have you or your partner been retrenched from your job in the past 6 months or will you be retrenched within the next 3 months?Please select... Yes No You are eligible for immediate access to Workforce Australia Services Please write the name of the organisation you or your partner’s position was retrenched from. Please provide written proof of retrenchment, such as a letter from your Employer or an Employment Separation Certificate which includes the date or expected date of retrenchment. For partners of retrenched workers: Please provide written proof of your partner’s retrenchment, such as a letter from your partner’s Employer or an Employment Separation Certificate which includes the date of retrenchment. If applicable, you will also need to provide evidence of living with your partner at the time of the retrenchment. Transition to Work eligibility questions: Do you have a year 12 Certificate or Certificate III or higher qualifications?Please select... Yes No What is the certificate/qualification? Did you get the certificate/qualification more than 6 months ago?Please select... Yes No Have you been working an average of 8 hours or more per week for the last 4 weeks (32 hours)?Please select... Yes No Have you worked in paid employment in the last 6 months? Are you currently enrolled in secondary education?Please select... Yes No Have you been enrolled in secondary education in the last 6 months?Please select... Yes No Have you attended secondary education in the last 4 weeks?Please select... Yes No Do you have an exemption from legal requirements to attend school?Please select... Yes No Tick to confirm the young person is eligible for direct registration (Group 2) in Transition to Work (as per Transition to Work guidelines).Yes I understand what Transition to Work Services I can receive, including what help I can access to improve my work readiness and examples of activities that I may take part in. Yes I agree to participate in Transition to Work Services for up to 18 months unless I advise my Transition to Work Provider that I no longer wish to participate.Yes Proof of Identity Do you have Drivers license number or Current Australian Passport or any other type of identification?Please select... Yes No Group A: You must provide one of the following: Drivers license number Current Australian passport number Other form of photo identification from a government department or agency Please specify type of identification. Identification number Group B: You must provide two of the following: Financial institution (bank) documents ATM/credit cards showing name and signature Bank statement showing your name and address Other documents—any of the following documents: Birth certificate or birth certificate extract Certificate of Australian citizenship Motor vehicle registration papers with current address Australian marriage certificate Documents showing registration of a change of name Divorce papers Trade certificate Insurance renewal documents showing current address Medicare card Other If other, please specify the type of the document Page 5 Thank you for your inquiry into our Self-Employment Assistance. It’s great you want to start a business! MTC will help guide you on which of the below options is best for you. One our experienced Business Coaches will be in contact with your shortly to help guide you on your best option. Certificate III in Entrepreneurship and New Business (BSB30220) This course will give you the skills to develop a Business Plan and run a business.Micro Business Skill Set (BSBSS00102)This course will give you specific skills in researching business opportunities and developing a Business Plan.New Business Ventures Skill Set (BSBSS00103)This course will give you skills to develop a business idea, create a proposal and organise finances.Exploring Self-Employment WorkshopThis workshop will give you the tools and resources to develop your idea into a business. Thank you. Thank you for your information. Our Customer Care team will be in contact with you within 1-2 business days so we can further understand your needs and how we can best assist you Contact Information
