Register Interest – Super Retail Group Step 1 of 3 33% Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Email(Required) Phone(Required)Address(Required) Street Address Address Line 2 City State / Province / Region ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Date of Birth(Required) DD slash MM slash YYYY PositionsWhich Super Retail Group brand(s) have you worked for since 2019? Supercheap Auto Rebel Sport BCF Macpac On what basis were you employed to work at Super Retail Group since 2019?(Required) Full Time Part Time Casual What were your position title(s)?(Required) Are you still employed by the Super Retail Group?(Required)Yes/NoYesNoStart date at Rebel Store(Required) DD slash MM slash YYYY write down the first of the month if you cannot recall the exact dayEnd date at Rebel Store DD slash MM slash YYYY write down the first of the month you cannot recall the exact day, if you are still working there please feel free to leave it emptyStart date at Supercheap Auto(Required) DD slash MM slash YYYY write down the first of the month if you cannot recall the exact dayEnd date at Supercheap Auto DD slash MM slash YYYY write down the first of the month if you cannot recall the exact day, and if you are still working there please feel free to leave it emptyStart date at BCF(Required) DD slash MM slash YYYY write down the first of the month if you cannot recall the exact dayEnd date at BCF DD slash MM slash YYYY write down the first of the month if you cannot recall the exact day, and if you are still working there please feel free to leave it emptyStart date at Macpac(Required) DD slash MM slash YYYY write down the first of the month if you cannot recall the exact dayEnd date at Macpac DD slash MM slash YYYY write down the first of the month if you cannot recall the exact day, and if you are still working there please feel free to leave it emptyWhich Rebel Store location(s) have you worked at since 2019?(Required) Which Supercheap Auto store location(s) have you worked at since 2019?(Required) Which BCF store location(s) have you worked at since 2019?(Required) Which Macpac store location(s) have you worked at since 2019?(Required) OvertimeDid you work hours that were unpaid?(Required)Yes/NoYesNoWere you regularly required to start work before your rostered start time?(Required)Yes/NoYesNoWere you regularly required to end work after your rostered end time?(Required)Yes/NoYesNoWhere you worked a shift beyond 5 hours, were you able to take a full uninterrupted meal break?(Required)Yes/NoYesNoDid you receive proper payment under the Retail Industry General Award for overtime rates, penalty rates and/or public holidays?Yes/NoYesNoList what you believe you did not receive proper payment for Are there any further issues you would like to raise in respect of any underpayment? Would you be willing to complete an Authority to Release form, granting Adero Law permission to request your employment records from Super Retail Group?(Required)Yes/NoYesNoATAI HEREBY AUTHORISE Adero Pty Ltd trading as ADERO LAW (Adero) to be provided with any and all documents pertaining to my employment with Super Retail Group and otherwise act on my behalf.SignatureName of Signee
