Client Information Sheet

1.Name* :
2.Date of Birth* (MM/DD/YYYY):
3.Phone no* :
4.Address* :
5.E-mail* :

Qualifications (Discipline / Field of Study) University (Not College) Class/Grade Class/Grade Year of Completion

6.Employment Details : Total Work Experience so far ?
Years Months

SI.N0 Name of Employer Designation / Position From To
Provide brief details of ROLES / RESPONSIBILITIES (Attach RESUME / CV if readily available)

7. Miscellaneous Information - Attach Separate sheet for the following :
  1. More than 4 employments (if applicable)  
    Yes No
  2. Spouse details (if applicable)   
    Yes No
  3. Relative in Australia (if applicable)   
    Yes No
  4. Any other information (that may ASSIST or be DETRIMENTAL for your migration to Australia)

For Office Use Only
Prospective Client : YES / NO Client No.: Issued BEC on
Remarks (if any) :
Signature of Scrutiny Officer Date :