Accent Group | Expression of Interest Step 1 of 3 33% Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Email(Required) Phone(Required)Address(Required) Street Address 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 Which Accent Group brands have you worked for since 2016?(Required) Hype DC Platypus Glue Store Sketchers Vans The Athlete's Foot Timberland Dr Martins CAT Other Other brand(Required) Which Accent Group store location(s) did you work at since 2016?(Required) Which of the following positions have you held at Accent Group since 2016?(Required) Store Manager Assistant Store Manager 3IC Duty Manager Full-Time team member Part-Time team member Casual team member Area Manager/Regional Manager Other Other position:(Required) Start Date(Required) DD slash MM slash YYYY Are you still employed at Accent Group?(Required)-YesNoEnd Date(Required) DD slash MM slash YYYY On what basis have you been employed to work at Accent Group since 2016?(Required) Full Time Part Time Casual Were you regularly required to start work before your rostered start time?(Required)YesNoWere you regularly required to end work after your rostered end time?(Required)YesNoWhere you were required to work shifts beyond 5 hours, were you able to take a full uninterrupted meal break?(Required)YesNoWould you be willing to complete an Authority to Release form, granting Adero Law permission to request your employment records from Accent Group?(Required)-YesNoIf so, please complete the form on the following page. Employee Name(Required) Dr.MissMr.Mrs.Ms.Prof.Rev. Prefix First Last Date of Birth(Required) DD slash MM slash YYYY AUTHORITY TO RELEASE INFORMATION I HEREBY AUTHORISE AND DIRECT YOU to RELEASE to my lawyers, ADERO LAW of 3 Hobart Place, (PO Box 5121) City ACT 2601 copies of documents pertaining to my employment, payroll and time and attendance, and/or such other documentation and/or information requested by them.Date(Required) DD slash MM slash YYYY Signature(Required)
