Business Licensing Authority
Tel: 1300 13 54 52
NRS 133 677
If completing this form
by hand, please
complete details in
blocks letter, using a
black or blue pen.
Send this form to:
Business Licensing
Authority
GPO Box 322B
MELBOURNE 3001
Website: www.consumer.vic.gov.au/bla
Email: [email protected]
ABN 32 790 228 959
Notice of Employment
(Agent’s Representatives and Licensed Employees)
Section 24B and 35(6) of the Estate Agents Act 1980
Important information

You must complete all fields on this form. Incomplete or missing information will not
be processed.
 Do not attach any eligibility documentation relating to the persons listed on this form.
Eligibility documentation must be retained in the files of the estate agency business.
You can also lodge notification online at www.consumer.vic.gov.au/estateagents.
1. Details of employer
Name of company or licensed estate agent
Licence number
Address of principal office
Postcode
Contact person
Daytime telephone number
Email address
2. What are you notifying of? (Select all that apply)
New agent’s representative(s) or changing existing agent representative’s hours.
Complete section 3. and sign at 6.
New licensed employee(s). Complete section 4. and sign at 6.
Ceasing agent’s representative(s) or licensed employee(s). Complete section 5.
and sign at 6.
Privacy
The Business Licensing Authority is committed to responsible and fair handling of personal information consistent
with the Privacy and Data Protection Act 2014 and its obligations under the Business Licensing Authority Act
1998. The information provided on this form will be placed on a register in accordance with the Estate Agents Act
1980 and may be inspected by the public. Please refer to our privacy and public register statements available at
www.consumer.vic.gov.au/bla.
(19/12/14)
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Notice of Employment (continued)
3. New agent’s representatives or amending existing agent’s representative hours
How employed?
(Full time or part time – for
Title
Surname (family name)
Given names
part time, specify number of
hours per week)
No. hours
Date of birth
F/T
P/T
F/T
P/T
F/T
P/T
F/T
P/T
Date starting
(DD/MM/YYYY)
4. New licensed employees
How employed?
Title
Surname (family name)
Given names
(Employee only, working
director)
Licence no.
Date starting
(DD/MM/YYYY)
5. Ceasing employees (both agent’s representatives and licensed employees)
Date ceasing
Title
Surname (family name)
Given names
Licence no. (if applicable)
(DD/MM/YYYY)
6. Signature of officer in effective control
(or licensed estate agent employer if a sole trader or in a partnership)
For all new agent’s representative employees notified in this form, including those who may be currently employed by
another licensed estate agent, I certify that:





I have sighted a copy of the agent’s representative prescribed course qualifications.
I have sighted a Victoria Police or CrimTrac records check about the agent’s representative(s) that is either less
than six months old, or if older than six months is accompanied by a statutory declaration stating that he or she
has not been found guilty of a disqualifying criminal offence.
I have taken reasonable steps to ensure that the person is eligible to be employed as an agent’s representative.
For this purpose I am aware that the Business Licensing Authority on its website has a declaration form that can
be completed by the agent’s representatives that I propose to employ.
I have provided the agent’s representative with a written authority to perform the duties of an estate agent.
I understand it is an offence to not do any of the above steps under section 16(4) of the Estate Agents Act 1980.
Signature of officer in effective control (or licensed estate agent employer if a sole trader or partnership)
X
Printed name
Date
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