Form 1

Skilled - Nominated (subclass 190) NSW Nomination Application FormSkillSelect EOI Number (mandatory)Applicants will be nominated against this EOI Number only Valid for 1 nomination attempt only

Title:

Last Name (as shown on passport):First Name (as shown on passport):

Date of birth:

Age:

Country of Birth:

Citizenship:

No. of Dependents:

Passport No.:

Australian Visa Held (if any): Visa No.: Expiry Date:

Address:

Tel No (incl. country code):Email:

EDUCATION list from most recent Qualification/s Course Date Completed Name of Institution

SKILLS ASSESSMENT RESULT

Nominated Occupation

ANZSCO Code

Assessing Authority (eg ACS, CPA)

Outcome FORMCHECKBOX Positive FORMCHECKBOX Other

ENGLISH LANGUAGE TEST RESULT (IELTS or OET)ListeningReadingWritingSpeakingOverall

EMPLOYMENT HISTORY list from most recent Occupation Employer Date Commenced

OTHER INFORMATION

Migration Agent details (if any):

Name:

MARA Registration No:

Address:

Tel:

Email:

NSW PROMOTIONSDid you meet with a NSW Government representative at a recent Expo or promotional event? FORMCHECKBOX Yes FORMCHECKBOX No If yes please advise where and when

PAYMENTEnclosed is a bank cheque/money order for $300 (offshore) or $330 incl. GST (onshore).Payable to: NSW Trade and Investment

Please write your FULL NAME on the back of the bank cheque or money orderI understand that this payment is non-refundable

DECLARATIONI declare that the above information is true and accurate and that I am confident I meet all the Commonwealth/NSW criteria for this visa. If granted a Skilled Nominated visa by DIAC, I agree to advise NSW Trade & Investment of my address on arrival in Australia (if not already living in NSW) and within 28 days of any change in home or business address during the first two years that I hold this visa. I will respond to NSW Trade & Investment surveys or requests for updated information on employment and settlement in NSW.

_________________________________________

_________________________________

Applicants Signature

DateSELF ASSESSMENTA self-assessment does not guarantee NSW State nomination. Your application will still be rigorously assessed on the information and documents provided at time of request for nomination.For more detailed information on the criteria and assessment guidelines, please refer to Booklet 6 on the Department of Immigration and Citizenship website www.immi.gov.au

You should ensure that you include all appropriate evidence to support your claims. Incomplete applications will result in processing delays.

Please circle the points that most accurately reflect your response to each criteriaCriteriaDescriptionPoints

Age at time of invitation1824 (inclusive)25

2532 (inclusive)30

3339 (inclusive)25

4044 (inclusive)15

4549 (inclusive)0

English Language Ability at time of invitationCompetent EnglishIELTS 6 / OET B0

Proficient EnglishIELTS 7 / OET B10

Superior EnglishIELTS 8 / OET A20

Educational Qualificationsat time of invitationDoctorate from an Australian educational institution or a doctorate awarded by an overseas educational institution of a recognised standard20

At least a Bachelor degree, including a Bachelor degree with Honours or Masters, from an Australian educational institution or a bachelor qualification awarded by an overseas educational institution of a recognised standard15

Diploma or trade qualification awarded by an educational institution in Australia, or qualification or award recognised by the relevant assessing authority in determining your skills for your nominated occupation10

Skilled Employment at time of invitation

A maximum of 20 points can be awarded for any combination of overseas and Australian skilled employment in your nominated occupation

Skilled employment outside Australia (in the last 10 years)

At least three but less than five years5

At least five but less than eight years10

At least eight and up to 10 years 15

Skilled employment in Australia (in the last 10 years)

At least one but less than three years 5

At least three but less than five years10

At least five but less than eight years15

At least eight and up to 10 years 20

Australian Study Requirementsat time of invitationOne or more degrees, diplomas or trade qualifications awarded by an Australian educational institution and meet the Australian Study Requirements5

Other factorsat time of invitationCredentialed community language qualificationsAccreditation is by NAATI at the paraprofessional level or above5

Studying and living in regional Australia or a low population growth metropolitan area (excluding distance education)5

Partner skill qualificationsMust provide passport, skills assessment, English language ability evidence5

Professional Year in Australia for at least 12 months in the four years before the day you were invited5

Nomination/Sponsorship

Nomination by New South Wales Visa subclass 190 ONLY5

TOTAL POINTS

OFFICE USE ONLY:

T & I REFERENCE No. __________

Approved

Declined

Anomalies:

Authorising Officer SignatureDate

DECLARATION BY APPLICANT AND MIGRATION AGENT

Limitations of State Nomination

NSW is keen to attract talented and energetic skilled migrants in areas of strategic economic value to the State.

Obtaining State Nomination is one step on the path for particular classes of skilled migrants to obtain an Australian visa. All applications are treated on their merits and applicants who meet State and Commonwealth Government criteria and who submit a properly documented application have a reasonable chance of success. However such success is never guaranteed, either at the outset or during the processing of any application.

NSW Trade & Investment requires that applicants applying for NSW State Nomination acknowledge the limitations of nomination. You should be aware that:

The Government of Australia, not individual States, has sole responsibility for granting visas to enter or stay in Australia. Approval of NSW State nomination for a particular applicant by NSW Trade & Investment does not constitute the granting of a visa to enter or stay in Australia. Approval of NSW State nomination by NSW Trade & Investment does not in any way imply that a visa application will be approved by the Government of Australia. Approval of NSW State nomination by NSW Trade & Investment does not imply that the State of NSW will automatically approve subsequent applications for State nomination.

APPLICANT DECLARATION1You, the Primary Applicant, are asked to make the following declaration:

I have read the facts listed above. I understand these facts and I give my permission for NSW Trade & Investment to share and exchange information with NSW Government agencies participating in this program and the Australian Government for the purpose listed above. 2 Signature of Primary Applicant:

Name of Primary Applicant:

Date of signature:

MIGRATION AGENT DECLARATION

I,

And acting on behalf of

Certify that: I have informed the applicant of the facts listed above.

I believe that the applicant understands these facts.

Signature of Migration Agent:

Date of signature:

1 Must be the person lodging the application.2 Any personal information provided to NSW Trade and Investment is voluntary and protected by the Privacy and Personal Information Protection Act 1998 (NSW). The information is essential to determine the Applicant's eligibility for the NSW State sponsored business migration program and may be disclosed to the Commonwealth and NSW Government agencies as described above. The information may also be used to send the Applicant communications such as newsletters, flyers and invitations about business-related activities. Please refer to our website www.business.nsw.gov.au for more information on our privacy policy and the Applicants rights to access or correct the information. DOCUMENT CHECKLIST There are several documents that you will have to provide with your application as evidence of your identity and to show that you meet the selection criteria. To assist in ensuring that you have provided all necessary documents please tab the documents 1, 2, 3, etc and tick the box against the tab description below to indicate you have provided the document.

(Note all Documents must be certified by a qualified party eg. Justice of the Peace, solicitor, magistrate or notary public and translated by a NAATI1 accredited translator).

Tab 1Skilled Nominated (subclass 190) Visa Application Form FORMCHECKBOX

Tab 2Full Curriculum Vitae /ResumeMust clearly state skills, qualifications and work experience to date FORMCHECKBOX

Tab 3Skills Assessment by appropriate Australian Assessing Authority2 FORMCHECKBOX

Tab 4Bio Page of Passport Existing Australian visa (if applicable) FORMCHECKBOX

Tab 5English Language Ability Test ResultsIELTS or OET FORMCHECKBOX

Tab 6Qualifications Certificates and academic transcript FORMCHECKBOX

Tab 7Employment ReferencesCertified, signed, dated and meeting all requirements in DIAC3 Booklet 6 FORMCHECKBOX

OPTIONAL (recommended)

Tab 8Letters of Reference(Certified, signed and dated) FORMCHECKBOX

Tab 9Letters of Appointment(Contracts of Employment) FORMCHECKBOX

Tab 10Payroll Records FORMCHECKBOX

OTHER

Tab 11 FORMCHECKBOX

Tab 12 FORMCHECKBOX

Tab 14 FORMCHECKBOX

Tab 15 FORMCHECKBOX

1 The National Accreditation Authority for Translators and Interpreters maintains a list of accredited translators and interpreters www.naati.com.au2 See the Department of Immigration and Citizenship website for the Australian Assessing Authority for each occupation www.immi.gov.au3 Department of Immigration and Citizenship

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