Self-Employment Assistance Online Registration

Are you of Aboriginal or Torres Strait Islander origin?*

Yes, Aboriginal Yes, Torres Strait Islander Yes, Aboriginal and Torres Strait Islander No, neither Aboriginal nor Torres Strait Islander

Are you an Australian Citizen or a visa holder with working rights?

Yes No

Do you have access to a computer and Microsoft Office, and are you comfortable using it?

Yes No

Have you previously received NEIS or Self-employment Assistance mentoring in the past 12 months?*

No Yes

Which of these options best describes your current employment status?*

Which if any of the following Centrelink payments are you receiving?*

Your Jobseeker ID Centrelink Reference Number (if known)

Dedicated Employment services provider (if relevant)

Are you an UNDISCHARGED Bankrupt?*

No Yes

Do you have any criminal convictions?*

A requirement of the program is to obtain business insurance when you start your business. If you have been convicted of a criminal offence within the past 5 years, you may face a problem obtaining insurance for your business. Have you been convicted of a criminal offence in the previous five years?

No Yes

Which statement best describes you?*

Small Business Coaching supports individuals to start their own small business as well as those who are already operating their own business.

Applying as a current business owner Individual looking to start a business

Do you have an existing business?*

No Yes

If you answered yes above, is your business more than six months old?

No Yes

If you answered yes above, what was your business’ net profit in the last financial quarter?

Brief description of your proposed / current business*

Why do you wish to pursue this as a business?*

Have you undertaken any market research?*

No Yes

Do you have the equipment/facilities required to start/run this business?*

No Yes

Are you thinking of starting your business with a business partner?*

No Yes

What education, skills & experience do you have that can be used in your business?*

The training provided is practical and small business focussed. It will build your knowledge and awareness of areas such as sales, marketing, financial management and business planning. Are you seeking to participate in business training to start your small business journey?*

Small Business Coaching supports the development and growth of your new small business. The core of the program is business training to successfully launch, manage and grow your business.

No Yes

How soon are you hoping to get started?*

Do you have any questions for us, or messages to consider when assessing your application?

Lastly, for our own marketing purposes, could you please tell us how you heard about the Self Employment Assistance Program?*

I certify that the information that I have supplied on this form is complete and correct to the best of my knowledge and I acknowledge that false information may lead to refusal, suspension or termination from the program.*

I Agree

Ensure all fields are complete before clicking submit

Upon submitting this online registration form you will receive a call from our team (within 2 business days), Please indicate in the field below the best day and time (Monday-Friday, 9am-5pm) for them to call you. If you miss our call, please contact us back on 1300 436 756.

Self-Employment Assistance Online Registration Form

Ensure all fields are complete before clicking submit