Participation Activity Record Form - Department Of Human Services (1) (1).pdf 22271c
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Participation Activity Record
You should use this form to keep a record of your jobsearch efforts and/or activities as outlined in your Employment Pathway Plan/Individual Participation Plan for the period shown below as we may ask you to provide this information at any time. You should complete this form when you look for work or participate in an approved activity. If you participated in more than 2 approved activities, provide the details in question 6 or on a separate sheet. Once this form is filled in, if you still need to record more jobsearch efforts or activities, you can start a new Participation Activity Record or record the details on a separate sheet. You do not have to complete the following information for any time during this period that you had an exemption. Your Centrelink Reference Number 1 Your full name
2
For the period:
3
You are required to look for
4
During this period did you participate in an approved activity? No Go to next question Yes
5
From
/
/
To
/
/
jobs per fortnight and bring this completed form to your next appointment on
Date started activity
Approved activity name
/
/
Hours per fortnight
Date stopped activity
1
/
/
/
/
2
/
/
/
/
If you had a requirement to look for work you should record your job s below. We may employers to details. Employer’s business name number Type of job Method of Date of 1
(
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/
/
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/
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Notes/Referrals/Activities (include appointments, other activities or things you may wish to record including any issues you may have had)
SU663.1307
2 of 2
You should use this form to keep a record of your jobsearch efforts and/or activities as outlined in your Employment Pathway Plan/Individual Participation Plan for the period shown below as we may ask you to provide this information at any time. You should complete this form when you look for work or participate in an approved activity. If you participated in more than 2 approved activities, provide the details in question 6 or on a separate sheet. Once this form is filled in, if you still need to record more jobsearch efforts or activities, you can start a new Participation Activity Record or record the details on a separate sheet. You do not have to complete the following information for any time during this period that you had an exemption. Your Centrelink Reference Number 1 Your full name
2
For the period:
3
You are required to look for
4
During this period did you participate in an approved activity? No Go to next question Yes
5
From
/
/
To
/
/
jobs per fortnight and bring this completed form to your next appointment on
Date started activity
Approved activity name
/
/
Hours per fortnight
Date stopped activity
1
/
/
/
/
2
/
/
/
/
If you had a requirement to look for work you should record your job s below. We may employers to details. Employer’s business name number Type of job Method of Date of 1
(
)
/
/
2
(
)
/
/
3
(
)
/
/
4
(
)
/
/
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SU663.1307
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Continued Employer’s business name
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number
Type of job
Method of
Date of
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Notes/Referrals/Activities (include appointments, other activities or things you may wish to record including any issues you may have had)
SU663.1307
2 of 2
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