Application for Review (Education)

South Australian Employment Tribunal

Form A65 – Application for Review (Education)

Form A65

Application for Review (Education)

Case Number
(SAET use only)

About this form

·  This is the approved form for an employee applying for a review of an employment decision under the Education Act 1972 and regulations.

·  The timeframes in which this form must be lodged are detailed below.

·  Submitting an incomplete form (including any relevant supporting documents) may result in delays.

Application TYPE

Please select the type of decision you are applying to have reviewed. Please note the legislative provisions under the Education Act 1972 and the timeframe in which an application must be lodged with SAET.

Type of decision to be reviewed (Education Act 1972 reference): / Application must be lodged within:
☐ decision to retrench an officer (section 16) / 14 days of receiving notice of a determination
☐ decision to transfer, vary duties and reclassify, grant leave or recommend retirement of an officer due to incapacity (section 17)
☐ decision to take disciplinary action (section 26)
☐ decision related to a teacher’s complaint against an officer of the Department (regulation 36)
☐ decision related to a reclassification application (section 30) / 30 days of receiving notice of a determination
☐ decision related to a provisional recommendation for an appointment to a promotional level (section 53) / 14 days of receiving notice of a determination (may be extended by 7 days for sufficient and reasonable cause)

Party details

Applicant

Title / ☐ Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Other (specify):
First name / Last name
Email
Telephone / Mobile
Address Street 1
Street 2
Suburb / State / Postcode
Department / Agency
Current role title / Classification
Is anyone representing you? / ☐ No ☐ Yes. Please specify:

Representative detail (if required)

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

Decision-maker

Role / ☐ Director-General / Chief Executive ☐ Other (specify):
Department / Agency
Title / ☐ Mr ☐ Mrs ☐ Miss ☐ Ms ☐ Other (specify):
First name / Last name
Email
Telephone / Mobile
Address Street 1
Street 2
Suburb / State / Postcode

Reviewable DECISION details

Is a copy of the decision attached to this application? / ☐ Yes ☐ No (please provide reason why)
Date of the decision
Date you receive notification of the decision?
Are you lodging this application within the prescribed timeframes? / ☐ Yes ☐ No (please provide full reason why below)

Why do you say that the decision is wrong? Please attach any supporting documentation.

What is the outcome you are looking for?

LODGING YOUR COMPLETED FORM

The person lodging this form must send a copy to all other party/ies.

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

www.saet.sa.gov.au

SAET Registry: 08 8207 0999