Workforce-Supplement-Certification by changcheng2

VIEWS: 290 PAGES: 2

									         AGED CARE WORKFORCE SUPPLEMENT CERTIFICATION FORM
                                     To be completed on an annual basis

PART A – Provider Details
 Legal Entity Name

  Postal Address

 Australian Business Number


PART B – Compliance Conditions
Question 1:    Are you an approved provider of residential care holding 50 or more places allocated for Yes / No
               the provision of residential care? If no proceed to question 2.
               (a) - Did you have an Enterprise Agreement in place on 1 July 2013?                     Yes / No

               (b) - If so was it varied to include the Workforce Supplement requirements by 31        Yes / No
               December 2013?

               What is the Fair Work Commission registered Enterprise Agreement Number or State
               Industrial Instrument Number?



               (c) - Where there was no enterprise agreement in place on 1 July 2013 was there an      Yes / No
               enterprise agreement in place on 30 June 2014 that includes the Workforce
               Supplement requirements?

Question 2:    Are you an approved provider of residential care with fewer than 50 places, a Home      Yes / No
               Care package provider, Multi Purpose Service or an organisation funded under other
               eligible programs.

               (a) - Did you have an Enterprise Agreement in place on 1 July 2013?                     Yes / No

               (b) - If so was it varied to include the Workforce Supplement requirements by 31        Yes / No
               December 2013

               What is the Fair Work Commission registered Industrial Enterprise Agreement
               Number or State Industrial Instrument Number?



               (c) - Where there was no enterprise agreement, were there workplace employment          Yes / No
               arrangements put in place by 30 June 2014 that meet the requirements of the
               Workforce Supplement
Question 3:    Have all employees, including new employees, been notified that your organisation is    Yes / No
               in receipt of the Aged Care Workforce Supplement
 Question 4:       All included employees have received wage increases as specified in Parts B and C,
                   subsections 3.2 paragraphs (a), (b) and (c) of the Workforce Supplement Guidelines:
                   (a)- Annual increase in base wages of 2.75 per cent per annum or FWC minimum                          Yes / No
                   wage increase whichever is greater;

                   (b) - Wages exceed relevant award rates by at least the percentage margin shown in                    Yes / No
                   Table 1 Per cent margin over the relevant award rates; and

                   (c) - The base wage has been increased by at least a further 1 per cent per annum                     Yes / No

 Question 5:       Minimum workforce commitments are in place as specified in section 3.3 Table 2
                   Summary of minimum commitments including:
                   (a) - Training and education opportunities for the employees ;                                        Yes / No

                   (b) - Career structures and career development for the employees; and                                 Yes / No

                   (c) - Workforce planning.                                                                             Yes / No

PART C – Declaration
I declare that:
1. I am authorised to sign on behalf of the approved provider or organisation; and
2. the information provided in this form is complete and correct; and
3. I understand that giving false or misleading information is a serious offence.

                        Authorised Person                                                         Witness

 Signature:                                                              Signature:

 Name:                                                                   Name:

 Job/Title:                                                              Job/Title:

 Date:                                                                   Date:

 Phone:                                                                  Phone:


 Please note that the Department of Health and Ageing must be notified of any changes in circumstances that may affect
 eligibility for the Workforce Supplement.

     Please return by either:
         Post: Forms Administration
                 PO Box 5008
                 NOWRA DELIVERY CENTRE NSW 2541
     Or Fax:     (02) 4447 8711 or e-mail: health@formsadministration.com.au

								
To top