All fields marked with an asterisk (*) are required
Scheme *

If you need to register for more than one scheme, you will need to complete a separate application.
Please insert a valid / active ABN.
Collection and Disclosure Statement

The Authority uses this form to collect information that it requires to register workers and employers and determine eligibility for entitlements under the Act, including personal information such as name, address, date of birth, payroll data and history, and leave history. The Authority needs this information to register you and to determine and manage your long service leave entitlements under the Act. If you do not provide the information, the Authority may not be able to make decisions about your long service leave entitlements under the Act. The Authority will only use and disclose your personal information to register you and manage your long service leave entitlements under the Act and where it is otherwise required or permitted by law to do so. In some circumstances, the Authority is required or authorised by law to release information to other government agencies, law enforcement bodies or to prevent serious and imminent threat to an individual's life, health, safety or welfare. In this context, such agencies could include the Australian Taxation Office, the Labour Hire and Licensing Authority, the Fair Work Ombudsman, the Victorian Work Cover Authority, Victoria Police, or your nominated banking institution.

The Authority will seek wherever possible to ensure that the personal information it collects, uses or discloses is accurate, complete and up to date. In many instances the Authority relies upon you to provide accurate and complete information and to advise the Authority should your circumstances change over time.

The Authority seeks to protect your personal information from misuse, loss, unauthorised access, modification or disclosure and securely destroys or de-identifies personal information when it is no longer needed for any purpose. In circumstances where personal information is collected and stored by external organisations the Authority uses to deliver aspects of its functions, the Authority’s contractual obligations require compliance with the same privacy and security standards.

You may obtain access to your personal information held by the Authority by contacting For further information about how the Authority handles your personal information, please visit the Authority’s Privacy Policy at