Ambler Collins - The Visa Specialists

Session 1 - Your Details
Enter the following details exactly as they appear in your passport
Family Name:
First Name:
Sex:
Date of birth:
Marital status:
Your place of birth
Town/City:
Country:
Your country of residence
Country of residence:

Session 2 - Your passport details
Passport number:
Country of passport:
Nationality of passport:
Passport date of issue:
Passport date of expiry:
Passport place of issue/issuing authority:
It is strongly recommended that the passport be valid for at least 6 months.
Warning: If you do not enter your passport details correctly, you may be refused or delayed entry into Australia until your identity and claims to enter Australia have been checked. Please note that documents usch as national identity cards are not acceptable for Australia visa application. Please only enter your passport number.
When do you propose to enter Australia using the visa that you are applying for now?
(DD/MM/YY)
Do you have any dependent children?		If yes please give details:
Are you known by any other name? (This includes names before marriage.)		If yes please give details:
Do you hold any other citizenship than that shown as your Passport Country above?		If yes please give details:
What is your usual occupation?
What employment do you intend to seek in Australia?
What is your highest qualification?

Session 3 - Residential address details
Give details of the residential address in your home country.
Address:
Suburb/Town:
State or Province:
Postcode:
Country:
Your contact telephone numbers
Home phone:
Work phone:
Mobile phone:
Email:
Skype:

Session 4 - Health declarations

During your proposed stay in Australia, do you intend to enter an Australian hospital or other health care facility (for example, a dentist surgery, private health care clinic, nursing home, pathology laboratory, ambulance station or community or rural nursing facility) for any purpose?Y/N

During your proposed stay in Australia, do you intend to be in a classroom situation for more than four (4) weeks?Y/N

During your proposed stay in Australia, do you intend to work in or attend an Australian preschool-aged child care centre (including preschools and creches) as an employee, trainee or student?Y/N

Have you:

Ever had, or currently have, tuberculosis?

Been in close contact with a person who has, or has has, active tuberculosis?

Ever had a chest X-ray which showed an abnormality?		If yes please give details:
Do you require assistance with mobility or care in Australia or overseas?		If yes please give details:
Do you intend to perform medical procedures (e.g. as a practising/trainee doctor, dentist, nurse, etc) during your stay in Australia?		If yes please give details:

During your proposed stay in Australia, do you expect to incur medical costs, or require treatment or medical follow up for:

blood disorders			If yes please give details:
cancer			If yes please give details:
heart disease			If yes please give details:
hepatitis B or C			If yes please give details:
HIV infection, including AIDS			If yes please give details:
kidney disease, including dialysis			If yes please give details:
liver disease
mental illness			If yes please give details:
pregnancy			If yes please give details:
respiratory disease that has required hospital admission			If yes please give details:
any form of surgery			If yes please give details:
any other health concerns			If yes please give details:
In the last five (5) years, have you visited or lived outside your home country for more than three (3) consecutive months (not including Australia)? Y/N			If yes please give details:

Note:
You are strongly advised to carry certification of your vaccination status, especially for children attending Australia child care centres (including preshcools and creches) and schools. Vaccinations against polio, tetanus, measles, mumps, rubella, diphtheria, pertussis (whooping cough), Haemophilus influenzae type B (Hib) and Hepatitis B is recommended for children, with certification sought at time of child care centre ( including preschools and creches) and school enrolment. Vaccination against rubella is also recommended for women of child bearing age.

Session 5 - Character declarations

Have you ever:

Been convicted of a crime or offence in any country (including any conviction which is now removed from official records)?		If yes please give details:
Been charged with any offence that is currently awaiting legal action?		If yes please give details:
Been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind?		If yes please give details:
Been removed or deported from any country (including Australia)?		If yes please give details:
Left any country to avoid being removed or deported?		If yes please give details:
Been excluded from or asked to leave any country (including Australia)?		If yes please give details:
Committed, or been involved in the commission of war crimes or crimes against humanity or human rights?		If yes please give details:
Been involved any activities that would represent a risk to Australian national security?		If yes please give details:
Had any outstanding debts to the Australian Government or any public authority in Australia?		If yes please give details:
Been involved in any activity, or been convicted of any offence, relating to the illegal movement of people to any country (including Australia)?		If yes please give details:
Served in a military force or state-sponsored or private militia, or undergone any military or paramilitary training in weapons or explosives use (however described), other than in the course of compulsory national military service?

Session 6 - Declaration
I certify that:
I have read and understand the information provided to me at the beginning of application, I am aware of the conditions that will apply to my visa and that I am required to abide by them. Y/N
I understand that the visa I am applying for does not permit me to be employed in Australia with one employer for more than 6 months. Y/N
I understand that the visa I am applying for does not permit me to undertake studies or training for more than 4 months. Y/N
I have sufficient funds for the initial period of my stay in Australia and for the fare to my intended overseas destination on leaving Australia. Y/N
Any employment is incidental to my holiday in Australia and the purpose of working is to supplement my holiday funds. Y/N
I am applying for a Working Holiday visa for the first time and have not previously entered Australia on a Working Holiday visa. (on a passport of any country) Y/N
I will respect Australian values as listed at the beginning of this application during my stay in Australia and will obey the laws of Australia. Y/N
I have truthfully declared all relevant details required of me in this application.
If granted a visa, I will advise the Australian Government of any change in my circumstances. Y/N

>Back to AmblerCollins Home Page