Department Of Immigration and Border Protection
Application for Employer Nomination
for a Permanent Appointment
Record of
Responses
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Terms and Conditions
I have read and agree to the
terms and conditions:
Yes
Business / organisation
Scheme details
Scheme type: Regional Sponsored Migration Scheme - visa subclass 187
Visa application stream: Direct entry
Business / organisation details
Legal registered name: Australian Medical and Dental Technology Pty Limited
Trading name: Australian Medical and Dental Technology Pty Limited
Industry type: Professional, Scientific and Technical Services
Date established or
commenced trading in
Australia:
15 May 2014
Registration identifiers
Give details of all registration identifiers for the business / organisation.
Give details of a registration identifier for the business / organisation.
Business registration type: Australian Business Number (ABN)
Business registration ID: 88169566009
Give details of a registration identifier for the business / organisation.
Business registration type: Australian Company Number (ACN)
Business registration ID: 169566009
Work location postcode
Give details of the postcode where the nominated person will be employed.
Postcode: 4563
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Business / organisation address details
Head office address
Give details of the business / organisation's head office address in Australia.
Note that a street address is required. A post office address cannot be accepted as a business /
organisation address.
Country: AUSTRALIA
Address: 9 Marion Street
Suburb / Town: AUBURN
State / Territory: New South Wales
Postcode: 2144
Postal address
Is the postal address the same as the head office address?
No
Country: AUSTRALIA
Address: PO Box 628
Suburb / Town: Parramatta CBD
State / Territory: New South Wales
Postcode: 2124
Contact person
Contact person details
Give details of the contact person within the business / organisation.
Family name: ABDUL
Given names: RAOUF
Postal address
Country: AUSTRALIA
Address: 9 Marion Street
Suburb / Town: AUBURN
State / Territory: New South Wales
Postcode: 2144
Application for Employer Nomination for a Permanent Appointment
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Contact telephone numbers
Business phone: 1300214921
Mobile / Cell phone: 0450330695
Electronic communication
We can communicate about this application more quickly using email and/or fax. Does the contact
person agree to this department communicating via email and/or fax? This may include receiving
notification of the outcome of the application.
Yes
Email address: amdt.technology2@gmail.com
Fax number: 0280886264
Authorised recipient
Does the applicant authorise another person to receive written correspondence on their behalf?
This authorises the department to send the authorised person all written correspondence that would
otherwise be sent directly to the applicant.
Yes, another person
This person is referred to as the 'authorised recipient'.
Authorised person
Authorised recipient contact details
Family name: ASLAN
Given names: Bassem
Postal address
Country: AUSTRALIA
Address: PO Box 628
Suburb / Town: Parramatta CBD
State / Territory: New South Wales
Postcode: 2124
Contact telephone numbers
Business phone: 1300214921
Mobile / Cell phone: 0450330695
Application for Employer Nomination for a Permanent Appointment
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Electronic communication
We can communicate about this application more quickly using email and/or fax. Does the authorised
recipient agree to this department communicating via email and/or fax? This may include receiving
notification of the outcome of the application.
Yes
Email address: amdt.technology2@gmail.com
Fax number: 0280886264
Position to be filled
Position details
Position: Pharmacy Technician
Occupation (ANZSCO) Pharmacy Technician
Address where nominated person will be employed
Country: AUSTRALIA
Address: Nandroya Road
Australia
Suburb / Town: Cooroy,Shire of Noosa,Sunshine Coast Re
State / Territory: Queensland
Postcode: 4563
Regional certification details
Has this nomination been certified by a Regional Certifying Body?
No
Terms and conditions that apply to current employees
Do you already have Australian employee(s) in your workplace doing the same work as the
nominated person?
No
Terms and conditions that will apply to the nominated person
Base rate of pay per annum: 62000
Guaranteed annual earnings: 62000
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Give details of how the base
pay and guaranteed annual
earnings were determined:
In accordance with applicable rates of pay
Will you make any deductions from these earnings apart from tax?
No
Will the business / organisation be paying the nominated person's salary?
Yes
Will the terms and conditions of employment of your Australian employee(s) apply to the nominated
person?
Yes
Employment and training details
Employment
Of the Australian operations of the business / organisation, what is the total number of:
Australian employees
(including Australian citizens
and permanent residents)
5
Foreign employees (i.e. non-
Australian citizens or nonpermanent
residents)
0
Of the total number of foreign employees, what is the number of:
Temporary business /
organisation entrants:
0
Overseas students: 0
Working holiday makers: 0
Other: 0
Training
What is the total number of Australian citizens or permanent residents employed in the business /
organisation as:
Professionals: 2
Tradespersons: 2
Recent Australian university
graduates with less than 12
months work experience:
0
Apprentices employed under
a training agreement or
contract of training:
0
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Other trainees employed
under a training agreement or
contract of training:
1
Gross payroll expenditure of
the business / organisation in
the past 12 months:
250000
Gross expenditure on
training Australian citizens or
permanent residents in the
past 12 months:
5000
Include paid study leave, accredited training courses, reimbursement of study related costs,
employment of designated training officers and the cost of in-house training.
Did the business / organisation make any contributions to an industry training fund in the past 12
months?
No
Nominated Person
Are the nominated person details available to be added?
Yes
Nominated person details
Family name: ALMOUSA
Given names: SALEH ALI MOHAMMAD
Sex: Male
Date of birth: 01 Jan 1980
Passport details
Are the details of a current passport available to be entered for the nominated person?
Yes
Enter the following details as they appear in the nominated person's passport.
Passport number: L129926
Country of passport: JORDAN - JOR
Nationality of passport holder: JORDAN - JOR
Date of issue: 22 Mar 2011
Date of expiry: 21 Mar 2016
Place of issue / issuing
authority:
JARASH JORDAN
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Place of birth
Town / City: KUFR KHALL
State / Province: JARASH
Country of birth: JORDAN
Residential address
Note that a street address is required. A post office address cannot be accepted as a residential
address.
Country: JORDAN
Address: KUFR KHAL
Suburb / Town: JARASH
State or Province: JARASH
Postal code: N/A
Contact telephone numbers
Business phone:
Mobile / Cell phone: 962797907786
Migrating family members
Are there any migrating family members included in this application?
No
ENS / RSMS Declarations
Warning:
Giving false or misleading information is a serious offence.
The applicants declare that they:
Have the authority to enter into legal commitments for the nominating business / organisation.
Yes
Will provide full-time employment for the visa applicant for at least two years.
Yes
Acknowledge that any resulting visa may be cancelled if holder does not commence work within six
months or does not continue to work in the nominated position for at least two years.
Yes
Acknowledge that any non-compliance with Australian agreements, awards and conditions may incur
penalties under Australia's industrial relations system and affect future immigration nominations.
Application for Employer Nomination for a Permanent Appointment
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Yes
Declarations
Warning:
Giving false or misleading information is a serious offence.
The applicants declare that they:
Have read and understood the information provided to them in this application.
Yes
Have provided complete and correct information in every detail on this form, and on any attachments
to it.
Yes
Understand that if any fraudulent documents or false or misleading information has been provided
with this application, or if any of the applicants fail to satisfy the Minister of their identity, the
application may be refused and the applicant(s), and any member of their family unit, may become
unable to be granted a visa for a specified period of time.
Yes
Understand that if documents are found to be fraudulent or information to be incorrect after the grant
of a visa, the visa may subsequently be cancelled.
Yes
Understand that if this application is approved, any person not included in this application will not
have automatic right of entry to Australia.
Yes
Will inform the Department of Immigration and Border Protection in writing immediately as they
become aware of a change in circumstances (including change of address) or if there is any change
relating to information they have provided in or with this application, while it is being considered.
Yes
Have read the information contained in the Privacy Notice (Form