Form A30
APPLICATION - UNFAIR DISMISSAL
Case Number
(SAET use only)
About this form

This is the approved form for lodging an unfair dismissal application with SAET in accordance with section
106 of the Fair Work Act 1994.

Regulations made under the Fair Work Act 1994 exclude certain employees from applying to SAET in
respect of their termination of employment.

An application must be lodged before the end of 21 days from the date the dismissal took effect. An
application for extension of time can be made in this form.

The Act provides for SAET to make an order for costs against either the employee or employer in certain
circumstances.

Submitting an incomplete form (including any relevant supporting documents) may result in delays.

A copy of this application is to be provided by the applicant to your former employer
NAME OF CASE AND PARTIES NAMES
IN THE MATTER of an application pursuant to Section 106 of the Fair Work Act 1994 between:
Applicant (employee)
Respondent(employer)
PARTY DETAILS
Employee / Applicant
☐ Mr
Title
First name
☐ Mrs
☐ Miss
☐ Ms
☐ Other (specify):
Last name
Email
Telephone
Mobile
Address
Street 1
Street 2
Suburb
State
Postcode
Country
Do you require an
interpreter?
☐ No
☐ Yes. Please specify language:
Do you have any special
requirements which will
require assistance?
☐ No
☐ Yes. Please specify:
Employer / Respondent
Organisation
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
1/4
South Australian Employment Tribunal
Form A30 – Application - Unfair dismissal
☐ Mr
Contact Title
☐ Mrs
☐ Miss
First name
☐ Ms
☐ Other (specify):
Last name
Email
Telephone
Address
Mobile
Street 1
Street 2
Suburb
State
Postcode
Country
ABOUT YOUR EMPLOYMENT
Type of work performed
for your employer
Work address
Street 1
Street 2
Suburb
State
Postcode
Country
Date when you first
worked for employer
Date termination of
employment took effect
Did you receive written
notice of termination or a
separation certificate?
☐ No
☐ Yes - please provide a copy
CATEGORIES OF EMPLOYMENT
Name of Award and
Agreement you were
employed under (if known)
Were you serving a period
of probation or qualifying
period of employment at
the time of your dismissal?
Type of employment
(mark all relevant boxes)
☐ No
☐ Yes
☐ Full-time
☐ Part-time
☐ Casual
☐ Apprenticeship or traineeship
☐ Contract of employment for a specified period or task
REASONS FOR APPLICATION
Brief summary of reasons given by employer for the termination and explain why you say your dismissal is harsh,
unjust or unreasonable.
Attach further pages if required. Only brief details are required. You will have an opportunity to expand on these
reasons at the conciliation conference, or later at arbitration if required.
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
2/4
South Australian Employment Tribunal
Form A30 – Application - Unfair dismissal
REMEDY SOUGHT
What remedy are you
seeking?
☐ Re-employment to your former position
(mark all relevant boxes)
☐ Re-employment to some
other position (specify)
☐ Monetary compensation
(specify amount)
S
EXTENSION OF TIME
Will this application be lodged within 21 days after the date the dismissal took effect?
☐ No – continue to next question
☐ Yes - SAET must decide whether or not to extend the time limit.
Pursuant to section 167 I apply for an extension of time in which to make this unfair dismissal
application. Please provide justification below.
REPRESENTATION
Is anyone representing
you?
☐ No
☐ Yes. Please specify:
Representative detail (if required)
Organisation
www.saet.sa.gov.au
SAET Registry: 08 8207 0999
Version as at 1 July 2017
3/4
South Australian Employment Tribunal
Form A30 – Application - Unfair dismissal
Contact First name
Last name
Email
Telephone
Address
Mobile
Street 1
Street 2
Suburb
Postcode
State
Country
OTHER PROCEEDINGS
Have you, or do you intend to initiate, other proceedings concerning this employer under this or any other Act or
with SAET?
☐ No
☐ Yes. Please specify:
LODGING YOUR COMPLETED FORM
I declare that all of the facts in this application are true and accurate to the best of my knowledge and belief:
Name of person lodging
Signature
Date
Please lodge this form, together with any accompanying documents, with the South Australian Employment
Tribunal:
Email: [email protected]
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
Version as at 1 July 2017
4/4