Online Australian Visa Assessment

Who is completing this Questionnaire?
Are you the main visa applicant? *

Yes No

Personal Particulars of the Main Applicant
Insert your details as they appear on your passport.

Prefex/Title

Given Names *

Surname *

State/Province

City/Town of Birth *

Country of Birth *

Relationship Status

is your current Relationship Status?

Contact Number

Home

Mobile *

Office/Work

Email *

EDUCATION DETAILS

Please provide details of your education, including appox dates you studied (To - From), courses completed and qualifications gained

CHILDREN & DEPENDENT FAMILY MEMBER'S

Do you or your Spouse/Partner (if applicable) have any children, step children or other dependent family members? *

Yes No

*Tick Yes even if these people will not be included in your application.
*You must include children from previous relationships even if they are not your (or your Partner's) biological child.
*A Dependent Family Member is any relative who relies on you or your Spouse/Partner for financial support to
meet the first person’s basic needs for food, clothing and shelter.

If you have answered yes to the above question please give details of your childrens, names and date of birth

Have you been to Australia on a working holiday visa before? *

Yes No

HEALTH DETAILS

Have you, or any other person included in this application, ever had or currently have tuberculosis; or been in close contact with a person who has or had turberculosis; or had a chest X-ray which showed an
abnormality? *

Yes No

Have you, or any other person included in this application have any of the following diseases, mental illnesses, conditions or disabilities that is or likely to require treatment/attention/care in Australia? *

Yes No

If you have answered yes please tick which of the following diseases, mental illnesses, conditions or disabilities that is or likely to require treatment/attention/care in Australia?

None Blood Disorder? Cancer ? Heart Disease ? Hepatitis B or C ? HIV or AIDS ? Kidney Disease ? Liver Disease ? Mental Illness ? Pregnancy? Respiratory illness ? Any form of surgery? Other health concern?

Do you, or any other person included in this application intend to, while in Australia:

(a) enter a hospital, nursing home or other health care facility?
*

Yes No

(b) work as, or study to be, a doctor, dentist, nurse or paramedic? *

Yes No

(c) work, or be a trainee, at a child care centre, preschool or creche? *

Yes No

(d) be in a classroom situation for more than 3 months as a teacher, student, lecturer or observer? *

Yes No

CHARACTER DETAILS
Have you, or any other person included in this questionnaire ever :

(a) been convicted or found guilty of a crime or offence* in any country (including spent convictions or any conviction which is now removed
from official records)? *

Yes No

(b) been charged with offence in any country that is currently awaiting
legal action? *

Yes No

(c) been confined in a prison or psychiatric institution by order of a court made in connection with criminal proceedings overseas or in Australia? *

Yes No

(d) been under a probation order, good behaviour bond, on parole, released on licence or subject to periodic detention overseas or in Australia? *

Yes No

(e) been acquitted of any criminal offence or other offence on the grounds of mental illness, insanity or unsoundness of mind? *

Yes No

(f) been removed or deported from any country, including Australia, for any reason? *

Yes No

(g) left a country (including Australia) to avoid being deported or removed? *

Yes No

(h) been excluded from or asked to leave any country (including Australia)? *

Yes No

(i) committed, or been involved in the commission of war crimes or crimes against humanity or human rights? *

Yes No

(j) been involved in any activities that would represent a risk to Australian national security? *

Yes No

(k) incurred a debt to the Australian Government or any public authority in Australia which is still outstanding? *

Yes No

(l) been involved in any activity, or been convicted of any offence,relating to the illegal movement of people to any country? *

Yes No

(m) been associated with or received training from an organisation engaged in violence, or been involved in an act of violence (including war, insurgency, freedom fighting, terrorism, protest) overseas or in
Australia ? *

Yes No

(n) been associated with or involved in a program related to the development of weapons of mass destruction? *

Yes No

(o) served in a military force or state sponsored/private militia, undergone any military/paramilitary training, or been trained in weapons/explosives use (however described)? *

Yes No

(p) been employed as an intelligence officer or an agent of an intelligence or security agency? *

Yes No

(q) not complied with a condition of a visa (whether an Australian visa or other country) or departed any country outside your authorised period of stay? *

Yes No

(r) provided information or a document to the Australian Department of Immigration and Citizenship or the Australian Customs Service which was wrong, incorrect, false or misleading? *

Yes No

(s) been convicted of a crime or offence in any country (including spent convictions or any conviction which is now removed from official records) relating to persons under the age of 16*? *

Yes No

*This may include but is not limited to child abuse, child sex, endangering a child, indecent dealings, possession of child pornography etc. If in doubt, tick yes.

(t) been charged with offence in any country that is currently awaiting legal action relating to persons under the age of 16*? *

Yes No

*This may include but is not limited to child abuse, child sex, endangering a child, indecent
dealings, possession of child pornography etc. If in doubt, tick yes.

Please list your work experience starting with most recent; including - dates, occupation & company.
(Alternatively you can copy and paste your CV into this window or attach below).

Attach a File

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