South Australian Employment Tribunal

Form A81 – Application for appeal against nomination (Fire and Emergency Services)

Form A81

Application for appeal against nomination (Fire and Emergency Services)

Case Number
(SAET use only)

About this form

  • This isthe approved form for an entitled officer or firefighter to appeal against the nomination of a person under section 29 of the Fire and Emergency Services Act 2005.
  • An appeal must be lodged within 14 days after the notice of the nomination is given.
  • Submitting an incomplete form (including any relevant supporting documents) may result in delays.

case and partY Summary

In the matter of an appeal against a nomination for a position under section 29 of the Fire and Emergency Services Act 2005:

Appellant(s) (name)
Respondent (name) / Chief Officer, South Australian Metropolitan Fire Service
Nominee that this appeal relates (name)
Date of notification of the nomination
Position nominee nominated for

Party details

Applicant

Title / ☐ Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Other (specify):
First name / Last name
Email
Telephone / Mobile
AddressStreet 1
Street 2
Suburb / State
Postcode / Country
Do you require an interpreter? / ☐ No ☐ Yes. Please specify language:
Do you haver any special requirements which will require assistance? / ☐ No ☐ Yes. Please specify:
Is anyone representing you? / ☐ No ☐ Yes. Please specify:

Representative detail (if required)

Organisation
Contact First name / Last name
Email
Telephone / Mobile
AddressStreet 1
Street 2
Suburb / State
Postcode / Country

Respondent

Organisation / South Australian Metropolitan Fire Service
Title / Chief Officer, South Australian Metropolitan Fire Service
First name / Last name
Email
Telephone / Mobile

First nominee appealed against

Title / ☐ Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Other (specify):
First name / Last name
Email
Telephone / Mobile

Second nominee appealed against

Title / ☐ Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Other (specify):
First name / Last name
Email
Telephone / Mobile

Details of Appeal

Orders sought

Specify the orders that you seek (if insufficient space, set out orders sought in a schedule attached to this application).

Grounds and reasons

Specify the grounds and reasons in support of this application (attach additional pages if necessary):

Extension of time

Is this application within 14 days after notice of the nomination? / ☐ Yes ☐ No, specify reasons why:

LODGING YOUR COMPLETED FORM

Name of person lodging
Signature
Date

Please lodge this form, together with any accompanying documents, with the South Australian Employment Tribunal:

Email:
Post: PO Box 3636, Rundle Mall, SA, 5000
In person: Level 6, Riverside Centre, North Terrace, Adelaide, 5000

PLEASE RETAIN A COPY OF THIS FORM FOR YOUR OWN RECORDS

SAET Registry: 08 8207 0999