JobAccess supplier nomination form

You can nominate to be listed as a supplier of products or services on our web site by submitting this supplier nomination form.

Your details
Business details
Products

Your details

Your contact details

So that we can contact you to discuss this form, please provide your contact details. These details will remain confidential and will not be used for any other purpose. These details will not appear on the web site.

Title: (required)

Given name: (required)

Family name: (required)

Please provide details of at least one contact method below:

Telephone area code: () Telephone number:

TTY area code: () TTY number:

Fax area code: () Fax number:

Mobile phone number:

Email address:

Terms and conditions

To submit a JobAccess supplier nomination you must have authority to nominate the business referred to in the form to be listed on the JobAccess web site.

By submitting the JobAccess supplier nomination form, you:

confirm that:
- you have authority to submit a JobAccess supplier nomination form;
- the details in this form are to the best of your knowledge, true and correct; and
- the business being nominated has a current Australian Business Number (ABN);
undertake to notify the JobAccess Adviser as soon as it is reasonably possible if the details for the nominated business or your contact details contained in this form change, including changes to the email and web site (URL); and
acknowledge that:
- the details supplied in this form will be listed on a public web site;
- being listed on the web site does not mean the Australian Government endorses you as a preferred supplier and does not entitle you to represent yourself or your business as being so endorsed; and
- you will be required to resubmit this form annually to continue your business’ listing on the web site.

Please check this box to indicate that you have read, understood and agree to the terms and conditions outlined above. (required)

Comments

Use this space to provide us with any additional comments (you can type up to 500 characters). This information will not appear on the web site. If a product or solution that you supply is not currently listed on the form, please provide details so that we can consider adding it to the site.

If you select cancel you will navigate away from this page and your changes will not be saved