South Australian Employment Tribunal

Form A36 – Application for release from agreement

Form A36

Application for release from agreement

Case Number
(SAET use only)

About this form

  • This is the approved form for applying for release from an agreement in accordance with the South Australian Fair Work Act 1994.
  • Submitting an incomplete form (including any relevant supporting documents) may result in delays.
  • A copy of this application is to be provided by the applicant to all other parties bound by the agreement (or their representatives).

Person/Organisation Filing Application

Name: ......

Contact: ......

(for corporations/organisations, include a contact person name)

Representative of (if applicable): ......

Address: ......

......

......

Telephone: ...... Facsimile: ......

Email: ......

The Application

Application is made pursuant to Section 85 by the party listed above as follows:

(mark only the relevant category)

To seek that SAET release a party from, or vary the terms of, an Agreement in consequence of industrial action - Section 85(1).

To seek that SAET include, omit or vary a stand down provision within an Agreement - Section 85(2).

Part 1: About the Agreement

(i) Title of Agreement sought to be varied or rescinded

Original File Number: ......

(ii)At what date is/was the term of the Agreement due to expire?

Part 2: Other Parties to the Application

For each of the other parties to the Agreement, please supply their name (organisation), contact person (if any) and other contact details:

Name:......

Contact Person: ......

Phone: ...... Fax: ......

Email: ......

Name:......

Contact Person: ......

Phone: ...... Fax: ......

Email: ......

Name:......

Contact Person: ......

Phone: ...... Fax: ......

Email: ......

Name:......

Contact Person: ......

Phone: ...... Fax: ......

Email: ......

Name:......

Contact Person: ......

Phone: ...... Fax: ......

Email: ......

Part 3: The Circumstances of the Application

(i)Describe the circumstances leading to the application and the grounds to be relied upon:

Part 4: The Substance of the Application

Set out the precise terms of the variation or release as sought:

(attach separate sheet if space is not sufficient)

LODGING YOUR COMPLETED FORM

I declare that all of the facts in this application are true and accurate to the best of my knowledge and belief:

Name of person lodging
Signature
Date

Please lodge this form, together with any accompanying documents, with the South Australian Employment Tribunal:

Email:
Post: PO Box 3636, Rundle Mall, SA, 5000
In person: Level 6, Riverside Centre, North Terrace, Adelaide, 5000

PLEASE RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS

SAET Registry: 08 8207 0999