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Register Interest Woolworths & Big W

Am I Eligible?

Thank you for registering your expression of interest in the Woolworths Group class action.
Please fill out the short questionnaire below.

Step 1 of 5

20%

1. Name*
Prefix First Middle Last
2. Phone*
Please add the country code prefix (+61 for Australia) followed by your mobile number
3. Email*
Enter Email Confirm Email
4. Address*
Street Address City State / Province / Region Post Code Country
5. Date Of Birth*
Date Format: DD slash MM slash YYYY
6. Are you willing to sign an authority that allows Adero Law to obtain your employment records from Woolworths Group?*
- Yes
- No
7. Were you employed by Woolworths supermarkets or Big W to work in a salaried supervisory or management position since November 2013?*
- Yes
- No
Note: This class action is only open to former or current salaried employees who have worked for Woolworths supermarkets or Big W since November 2013. If you worked at BWS, Dan Murphy's, Petrol, Thomas Dux, or Masters, were not salaried, or only worked prior to November 2013, please do not use this form.

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8. During your employment with Woolworths Group were you paid for every hour that you worked?*
- Yes
- No
9. Did you clock in and clock out using a time recording system (e.g. Kronos)?*
- Yes
- No
10. Were all of your hours ACCURATELY recorded in the time recording system (e.g. Kronos), capturing your start and finish times for every shift?*
- Yes
- No
If no, please detail why your time recordings were inaccurate:
Maximum 300 characters.
11. On average across your employment, how many hours did you work per FORTNIGHT?*
Please enter a number from 20 to 150.
If your fortnightly hours varied significantly, please enter the hours averaged across your most recent roles.
12. On average across your employment, how many public holidays did you work per YEAR?*
13. During your employment, were you paid for attending compulsory training and/or meetings?*
- Yes
- No
14.1. Did you receive an email or letter from Woolworths advising you of the outcome of your September 2017 to September 2019 pay review?*
If you worked for Woolworths/Metro during this period, you should have received the email or letter in late 2019 or early 2020.
Enter the value of your September 2017 to September 2019 pay review:*
14.2. Did you receive an email or letter from Woolworths advising you of the outcome of your March 2015 to September 2019 pay review?*
If you worked for Big W during this period, you should have received the email or letter in mid-2020.
Enter the value of your March 2015 to September 2019 pay review:*
14.3. Did you receive an email or letter from Woolworths advising you of the outcome of your March 2015 to September 2017 pay review?*
If you worked for Woolworths/Metro during this period, you should have received the email or letter in mid-2020.
Enter the value of your March 2015 to September 2017 pay review:*
Pay Review Total (Admin)
Upload a copy of your pay review letter(s)
Drop files here or
15. Were you directed to work additional hours?*
If so, who directed you to work those additional hours?*
16. Are you aware of any specific effects this claim will have on your personal circumstances? (E.g. Centrelink and tax implications) (optional)
Max 400 characters

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In the past 12 years, how many Woolworths supermarket and/or Big W locations did you work at as a salaried employee?*
Please exclude any time at stores where you worked in a casual/EBA position. If you worked at more than 6 stores, choose the 6 most recent.
Store Name (Store 1)*
Please begin with the most recent store.
Select the entity you worked for at this location: (Store 1)*
Select the salaried position title that best describes your job title at this Woolworths location: (Store 1)*
Select the salaried position title that best describes your job title at this Big W location: (Store 1)*
Select the Woolworths department you worked in: (Store 1)*
Enter your Woolworths position title: (Store 1)*
Max 30 characters.
Enter your Big W position title: (Store 1)*
Max 30 characters.
Was this position full time or part time? (Store 1)*
Enter your most recent annual salary for this position at this location: (Store 1)*
Please enter a number from 20000 to 120000.
Start Date (Store 1)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you started.
End Date (Store 1)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you finished.
Ordinary rostered start time at this location: (Store 1)*
Ordinary rostered end time at this location: (Store 1)*
Rostered finish time should be 9 hours from the rostered start time. Please be mindful of AM and PM.
Average actual start time at this location: (Store 1)*
Average actual end time at this location: (Store 1)*
Actual finish time does NOT need to be 9 hours from actual start time. Please be mindful of AM and PM.
On average, how many Saturdays did you work per fortnight? (Store 1)*
On average, how many Sundays did you work per fortnight? (Store 1)*
On average, how many hours of work did you perform away from the work site on your own time (e.g. rostering duties) each week? (Store 1)*
Please select the average number of hours from the drop down menu.
On average, how many minutes did you take for your meal break each day? (Store 1)*
Please select the average number of minutes from the drop down menu.
Store Name (Store 2)*
Maximum 40 Characters.
Select the entity you worked for at this location: (Store 2)*
Select the salaried position title that best describes your job title at this Woolworths location: (Store 2)*
Select the salaried position title that best describes your job title at this Big W location: (Store 2)*
Select the Woolworths department you worked in: (Store 2)*
Enter your Woolworths position title: (Store 2)*
Max 30 characters.
Enter your Big W position title: (Store 2)*
Max 30 characters.
Was this position full time or part time? (Store 2)*
Enter your most recent annual salary for this position at this location: (Store 2)*
Please enter a number from 20000 to 120000.
Start Date (Store 2)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you started.
End Date (Store 2)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you finished.
Ordinary rostered start time at this location: (Store 2)*
Ordinary rostered end time at this location: (Store 2)*
Average actual start time at this location: (Store 2)*
Average actual end time at this location: (Store 2)*
On average, how many Saturdays did you work per fortnight? (Store 2)*
On average, how many Sundays did you work per fortnight? (Store 2)*
On average, how many hours of work did you perform away from the work site on your own time (e.g. rostering duties) each week? (Store 2)*
Please select the average number of hours from the drop down menu.
On average, how many minutes did you take for your meal break each day? (Store 2)*
Please select the average number of minutes from the drop down menu.
Store Name (Store 3)*
Maximum 40 Characters.
Select the entity you worked for at this location: (Store 3)*
Select the salaried position title that best describes your job title at this Woolworths location: (Store 3)*
Select the salaried position title that best describes your job title at this Big W location: (Store 3)*
Select the Woolworths department you worked in: (Store 3)*
Enter your Woolworths position title: (Store 3)*
Max 30 characters.
Enter your Big W position title: (Store 3)*
Max 30 characters.
Was this position full time or part time? (Store 3)*
Enter your most recent annual salary for this position at this location: (Store 3)*
Please enter a number from 20000 to 120000.
Start Date (Store 3)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you started.
End Date (Store 3)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you finished.
Ordinary rostered start time at this location: (Store 3)*
Ordinary rostered end time at this location: (Store 3)*
Average actual start time at this location: (Store 3)*
Average actual end time at this location: (Store 3)*
On average, how many Saturdays did you work per fortnight? (Store 3)*
On average, how many Sundays did you work per fortnight? (Store 3)*
On average, how many hours of work did you perform away from the work site on your own time (e.g. rostering duties) each week? (Store 3)*
Please select the average number of hours from the drop down menu.
On average, how many minutes did you take for your meal break each day? (Store 3)*
Please select the average number of minutes from the drop down menu.
Store Name (Store 4)*
Maximum 40 Characters.
Select the entity you worked for at this location: (Store 4)*
Select the salaried position title that best describes your job title at this Woolworths location: (Store 4)*
Select the salaried position title that best describes your job title at this Big W location: (Store 4)*
Select the Woolworths department you worked in: (Store 4)*
Enter your Woolworths position title: (Store 4)*
Max 30 characters.
Enter your Big W position title: (Store 4)*
Max 30 characters.
Was this position full time or part time? (Store 4)*
Enter your most recent annual salary for this position at this location: (Store 4)*
Please enter a number from 20000 to 120000.
Start Date (Store 4)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you started.
End Date (Store 4)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you finished.
Ordinary rostered start time at this location: (Store 4)*
Ordinary rostered end time at this location: (Store 4)*
Average actual start time at this location: (Store 4)*
Average actual end time at this location: (Store 4)*
On average, how many Saturdays did you work per fortnight? (Store 4)*
On average, how many Sundays did you work per fortnight? (Store 4)*
On average, how many hours of work did you perform away from the work site on your own time (e.g. rostering duties) each week? (Store 4)*
Please select the average number of hours from the drop down menu.
On average, how many minutes did you take for your meal break each day? (Store 4)*
Please select the average number of minutes from the drop down menu.
Store Name (Store 5)*
Maximum 40 Characters.
Select the entity you worked for at this location: (Store 5)*
Select the salaried position title that best describes your job title at this Woolworths location: (Store 5)*
Select the salaried position title that best describes your job title at this Big W location: (Store 5)*
Select the Woolworths department you worked in: (Store 5)*
Enter your Woolworths position title: (Store 5)*
Max 30 characters.
Enter your Big W position title: (Store 5)*
Max 30 characters.
Was this position full time or part time? (Store 5)*
Enter your most recent annual salary for this position at this location: (Store 5)*
Start Date (Store 5)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you started.
End Date (Store 5)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you finished.
Ordinary rostered start time at this location: (Store 5)*
Ordinary rostered end time at this location: (Store 5)*
Average actual start time at this location: (Store 5)*
Average actual end time at this location: (Store 5)*
On average, how many Saturdays did you work per fortnight? (Store 5)*
On average, how many Sundays did you work per fortnight? (Store 5)*
On average, how many hours of work did you perform away from the work site on your own time (e.g. rostering duties) each week? (Store 5)*
Please select the average number of hours from the drop down menu.
On average, how many minutes did you take for your meal break each day? (Store 5)*
Please select the average number of minutes from the drop down menu.
Store Name (Store 6)*
Maximum 40 Characters.
Select the entity you worked for at this location: (Store 6)*
Select the salaried position title that best describes your job title at this Woolworths location: (Store 6)*
Select the salaried position title that best describes your job title at this Big W location: (Store 6)*
Select the Woolworths department you worked in: (Store 6)*
Enter your Woolworths position title: (Store 6)*
Max 30 characters.
Enter your Big W position title: (Store 6)*
Max 30 characters.
Was this position full time or part time? (Store 6)*
Enter your most recent annual salary for this position at this location: (Store 6)*
Please enter a number from 20000 to 120000.
Start Date (Store 6)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you started.
End Date (Store 6)*
Date Format: DD slash MM slash YYYY

If you cannot remember the exact date, please enter the 1st day of the month you believe you finished.
Ordinary rostered start time at this location: (Store 6)*
Ordinary rostered end time at this location: (Store 6)*
Average actual start time at this location: (Store 6)*
Average actual end time at this location: (Store 6)*
On average, how many Saturdays did you work per fortnight? (Store 6)*
On average, how many Sundays did you work per fortnight? (Store 6)*
On average, how many hours of work did you perform away from the work site on your own time (e.g. rostering duties) each week? (Store 6)*
Please select the average number of hours from the drop down menu.
On average, how many minutes did you take for your meal break each day? (Store 6)*
Please select the average number of minutes from the drop down menu.

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Tell us your story (optional)
If possible, upload Letters of Offer, payslips, Kronos data, or any other relevant documents
Drop files here or
Alternatively, email them to woolworths@aderolaw.com.au.
If possible, upload Letters of Offer, payslips, Kronos data, or any other relevant documents (ARCHIVED)
Upload any other relevant documents you have here (or email them to woolworths@aderolaw.com.au) (ARCHIVED)
Did you receive any benefits, TOIL, or loadings? (ARCHIVED)
(eg. performance bonuses)
Did you work additional hours over your contracted hours? (ARCHIVED)
If so, do you have any evidence to support this? (ARCHIVED)
Additional hours worked over 28 day cycle not included in Kronos data (ARCHIVED)
(eg. working additional hours that weren’t included on the roster or using the Kronos time and attendance system)
Number of weeks worked per year? (ARCHIVED)
(On average, excluding annual leave and sick leave taken)
What was your Job Title at Woolworths (ARCHIVED)
On average across your employment, how many weekends and public holidays did you work per fortnight? (ARCHIVED)
IF you selected other please enter your Job Title here (ARCHIVED)
Average number of weekend days you worked each week: (Store 1) (ARCHIVED)
Average number of weekend days worked each week: (Store 2) (ARCHIVED)
Average number of weekend days you worked each week: (Store 3) (ARCHIVED)
Average number of weekend days you worked each week: (Store 4) (ARCHIVED)
Average number of weekend days you worked each week: (Store 5) (ARCHIVED)
Average number of weekend days you worked each week: (Store 6) (ARCHIVED)
Store Name (7) (ARCHIVED)
Start Date (7) (ARCHIVED)
Date Format: DD slash MM slash YYYY
End Date (7) (ARCHIVED)
Date Format: DD slash MM slash YYYY
Store Name (8) (ARCHIVED)
Start Date (8) (ARCHIVED)
Date Format: DD slash MM slash YYYY
End Date (8) (ARCHIVED)
Date Format: DD slash MM slash YYYY
Store Name (9) (ARCHIVED)
Start Date (9) (ARCHIVED)
Date Format: DD slash MM slash YYYY
End Date (9) (ARCHIVED)
Date Format: DD slash MM slash YYYY
Store Name (10) (ARCHIVED)
Start Date (10) (ARCHIVED)
Date Format: DD slash MM slash YYYY
End Date (10) (ARCHIVED)
Date Format: DD slash MM slash YYYY

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Disclosure Letter

By signing below and submitting this form you:
- reasonably believe that you will be eligible to participate in the action;
- warrant that;
  - the information you have provided is true and correct; and
  - you will not sign-up or register using any false or misleading details;
- hereby execute and agree to be bound by and comply with the terms of the;
  - Retainer Agreement
  and consent to us entering the information you have provided to us into those documents
- have been given the opportunity to obtain independent legal advice as to the nature and effect of the Retainer Agreement, and you agree to be bound and comply with the terms of our Retainer Agreement.;
  - after obtaining, and in reliance on such independent legal advice; or
  - having elected not to obtain independent legal advice; and
    - you have read and understood the nature and effect of our Retainer; and
    - you do not require any explanation or advice in relation to those documents;
- consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and
- consent to receive further communications from us regarding any continued participation in the action.
Signature*
Please ensure your signature is entered so that Adero Law can act on your behalf.
Consent*
By submitting this form you:

Reasonably believe that you will be eligible to participate in the action;

Warrant that: the information you have provided is true and correct; and you will not sign-up or register using any false or misleading details;

Consent and authorise us to use the information provided to assess whether or not you may be eligible to participate in the action; and Consent to receive further communications from us regarding any continued participation in the action
I agree to the terms and conditions.
*
- I understand that the retainer and the disclosure letter are confidential documents. I understand that I am not permitted to share these documents or the information contained therein with any third party or for any purpose other than participating in the proposed proceedings.
If you would prefer to sign a hard copy of this agreement, please print out a copy of the Retainer Agreement, complete the Claimant Details in the document, sign it, and then scan it as a PDF and email it to: woolworths@aderolaw.com.au.

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