This form contains 83 fields organized into 27 sections. Below is a complete list of every field, its type, and what information is expected.

Field Name	Type	Description
Amount needed from us (Q15 $)
Q15 — Amount needed from us	Number	Enter the dollar amount you need the agency to pay for this item or service (minimum $50). Fill only if 'Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense' is 'Yes'.
Amount of money you have access to (Q9)
Q9: Amount of money you have access to	Number	Enter the total amount of money you can access right now, including cash and funds in bank or other financial institutions. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Can you afford to repay (Q4) - yes/no
Q4 - No (cannot afford to repay)	Checkbox	Check this box if you cannot afford to repay the Special Employment Advance.
Q4 - Yes (can afford to repay)	Checkbox	Check this box if you can afford to repay the Special Employment Advance.
Contact phone number (Q8)
Q8 Contact phone number (including area code)	Text	Enter your primary contact phone number including the area code (and country code if applicable); include any necessary digits, spaces or punctuation so we can call you. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 10 characters
Customer Reference Number (Q5)
Q5 Customer Reference Number — Part 1	Text	Enter the first group of characters from your Customer Reference Number (CRN) exactly as shown on Centrelink correspondence, including any leading zeros and without adding spaces or hyphens. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 3 characters
Q5 Customer Reference Number — Part 2	Text	Enter the second group of characters from your Customer Reference Number (CRN) exactly as shown on Centrelink correspondence, including any leading zeros and without adding spaces or hyphens. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 3 characters
Q5 Customer Reference Number — Part 3	Text	Enter the third group of characters from your Customer Reference Number (CRN) exactly as shown on Centrelink correspondence, including any leading zeros and without adding spaces or hyphens. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 3 characters
Q5 Customer Reference Number — Part 4	Text	Enter the final group of characters from your Customer Reference Number (CRN) exactly as shown on Centrelink correspondence, including any leading zeros and without adding spaces or hyphens. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 1 characters
Date of birth (Q7) - DD/MM/YYYY
Q7 Day (DD)	Text	Enter the day of your birth using two digits (DD), for example 05 for the fifth of the month. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 2 characters
Q7 Month (MM)	Text	Enter the month of your birth using two digits (MM), for example 04 for April. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 2 characters
Q7 Year (YYYY)	Text	Enter the year of your birth using four digits (YYYY), for example 1980. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 4 characters
Dates worked - First entry (Q18 row 1)
Entry 1 — From day	Date	Enter the day component of the date you started this period of work for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Entry 1 — From month	Date	Enter the month component of the date you started this period of work for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Entry 1 — From year	Date	Enter the year component of the date you started this period of work for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 4 characters
Entry 1 — To day	Date	Enter the day component of the date you finished this period of work for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Entry 1 — To month	Date	Enter the month component of the date you finished this period of work for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Entry 1 — To year	Date	Enter the year component of the date you finished this period of work for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 4 characters
Entry 1 — Amount not yet paid (before tax)	Number	Enter the total amount, before tax, of income for this work that has not yet been paid. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'.
Entry 1 — Expected payment day	Date	Enter the day component of the date you (or your partner) expect to receive this unpaid income for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Entry 1 — Expected payment month	Date	Enter the month component of the date you (or your partner) expect to receive this unpaid income for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Entry 1 — Expected payment year	Date	Enter the year component of the date you (or your partner) expect to receive this unpaid income for the first entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 4 characters
Dates worked - Second entry (Q18 row 2)
Second — From day	Date	Enter the day component of the start date for the second dates-worked entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Second — From month	Date	Enter the month component of the start date for the second dates-worked entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Second — From year	Date	Enter the year component of the start date for the second dates-worked entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 4 characters
Second — To day	Date	Enter the day component of the end date for the second dates-worked entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Second — To month	Date	Enter the month component of the end date for the second dates-worked entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Second — To year	Date	Enter the year component of the end date for the second dates-worked entry. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 4 characters
Second — Amount not yet paid (before tax)	Number	Enter the gross amount (before tax) of income from the second work period that has not yet been paid. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'.
Second — Expected payment day	Date	Enter the day component of the date you expect to receive this unpaid income for the second work period. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Second — Expected payment month	Date	Enter the month component of the date you expect to receive this unpaid income for the second work period. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 2 characters
Second — Expected payment year	Date	Enter the year component of the date you expect to receive this unpaid income for the second work period. Fill only if 'Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid' is 'Yes'. Max length: 4 characters
Debt with government (Q2) - yes/no
Q2 - No (Do you have a debt with government?)	Checkbox	Check this box if you do NOT have a debt with Services Australia or another Australian Government department (this does not include a Centrelink or Family Tax Benefit Advance); if checked, go to the next question.
Q2 - Yes (Do you have a debt with government?)	Checkbox	Check this box if you DO have a debt with Services Australia or another Australian Government department (this does not include a Centrelink or Family Tax Benefit Advance); if checked, you cannot get a Special Employment Advance.
Declaration and Signature
Declaration Agreement	Checkbox	Check this box to confirm that you have read, understood, and agree to the declaration statement provided above.
Declaration Day	Text	Enter the day of the month when this declaration is made, in DD format. Max length: 2 characters
Declaration Month	Text	Enter the month when this declaration is made, in MM format. Max length: 2 characters
Declaration Year	Text	Enter the year when this declaration is made, in YYYY format. Max length: 4 characters
Signature	Text	Provide your signature in this field if you are returning the form in person.
Employer address
Employer address — Street address	Text	Enter the employer's street address including unit or suite number, street number and street name. Max length: 40 characters
Employer address — Address line 2	Text	Enter any additional address details such as PO Box, building, floor or other secondary address information. Max length: 40 characters
Employer address — Suburb / Town / City	Text	Enter the suburb, town or city for the employer's address. Max length: 40 characters
Employer address — Postcode	Text	Enter the postcode for the employer's address (for example, the four-digit Australian postcode). Max length: 4 characters
Employer name
Employer name	Text	Enter the full name of your employer or the business name as it appears on your payslip or employment contract. Max length: 40 characters
Expense Amount
Expense Amount	Number	Enter the amount of money you need to meet your expenses.
Fortnightly income and expenses (Q3) - A/B/C
Q3 A — Total fortnightly income	Number	Enter the total fortnightly income (all earned income and any Centrelink payments) before deductions.
Q3 B — Total fortnightly expenses	Number	Enter the total fortnightly expenses (including food, rent, travel, utilities, loan or advance repayments and all ongoing payments).
Q3 C — Fortnightly excess (A − B = C)	Number	Enter the result of subtracting your total fortnightly expenses (B) from your total fortnightly income (A) to show your fortnightly excess.
General
Instructions	Button
Q11GoToQ18	Button
Q17GoToQ20.0	Button
Q17GoToQ20.1	Button
Clear	Button
Gross employment income per fortnight (Q16 $)
Q16 - Gross employment income per fortnight	Number	Enter the gross amount of employment income you expect to be paid each fortnight.
Item or service needed to start work (Q13)
Item or service needed to start work (Q13)	Text	Enter the name or brief description of the item or service you need before you can start the job (for example: tools, uniform, safety equipment, transport, training). Fill only if 'Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense' is 'Yes'.
Item/service cost (Q14 $)
Q14 Item/service cost	Number	Enter the total cost in dollars of the item or service you need before you can start work (the amount requested in question 14). Fill only if 'Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense' is 'Yes'.
Job expected start date (Q12 DD MM YYYY)
Job expected start day (DD)	Text	Enter the two-digit day of the month when the job is expected to start (DD). Fill only if 'Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense' is 'Yes'. Max length: 2 characters
Job expected start month (MM)	Text	Enter the two-digit month number when the job is expected to start (MM). Fill only if 'Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense' is 'Yes'. Max length: 2 characters
Job expected start year (YYYY)	Text	Enter the four-digit year when the job is expected to start (YYYY). Fill only if 'Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense' is 'Yes'. Max length: 4 characters
Name of contact person
Contact person name	Text	Enter the full name of the contact person (for example, first name and surname) who can be contacted about this employer. Max length: 40 characters
Payment received for 3 months (Q1) - answer and details
Q1 - No	Checkbox	Check this box if you have NOT been getting one of the payments listed for 3 months or more (so you cannot get a Special Employment Advance).
Q1 - Yes	Checkbox	Check this box if you HAVE been getting one of the payments listed for 3 months or more, and then provide the payment details requested below.
Q1 — Payment name or code	Text	Enter the short name or code of the payment you have been receiving for 3 months or more (e.g. benefit name or payment code). Fill only if 'Q1 - Yes' is 'Yes'.
Q1 — Payment details	Text	Provide full details about the payment you have been receiving for 3 months or more, such as the payment name, who pays it, start date, amount and any reference or account numbers. Fill only if 'Q1 - Yes' is 'Yes'. Max length: 40 characters
Phone number (including area code)
Phone number (including area code)	Text	Enter the employer or contact person's phone number including the area code, using any necessary spaces or separators (include country code if relevant). Max length: 10 characters
Privacy Notice Acknowledgement
Q20	Text	Max length: 1 characters
Q11 - Which one applies to you (options)
Q11 Option 1: You have been offered a job which will last at least 6 weeks but cannot afford an essential expense	Checkbox	Check this box if you have been offered a job that will last at least six weeks but you cannot afford an essential expense required to start work.
Q11 Option 2: You are short of money because you (or your partner) have worked but not yet been paid	Checkbox	Check this box if you (or your partner) have worked but have not been paid, do not expect to be paid within the next 2 days, and the unpaid earnings have reduced your Centrelink payment by at least 50%.
Q11 Option number	Text	Enter the number of the option on question 11 that applies to you (for example, enter 1 if you are short of money because you have worked but not yet been paid, or the other option number if the alternative applies).
Q17 - Someone else help with this expense (options and details)
Q17 - No (Go to 20)	Checkbox	Check this box if there is no one else (for example, no Employment Services Provider) who can help you with this expense; if checked, skip to question 20.
Q17 – Helper short name/identifier	Text	Enter a short name, organisation or brief identifier for the person or service provider who helps you with this expense.
Q17 - Yes (Give details below)	Checkbox	Check this box if someone else (for example, your Employment Services Provider) can help you with this expense, and provide their details in the space below.
Q17 – Helper details	Text	Provide full details about the person or organisation that helps with this expense, including their role, contact information and a description of the assistance provided. Fill only if 'Q17 - Yes (Give details below)' is 'Yes'.
Type of work
Type of work	Text	Enter a short description of the work you do for this employer (for example job title, main duties or industry). Max length: 40 characters
Your name (Q6) - title and given/family names
Title - Mr	Checkbox	Check this box if your title is Mr. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Title - Mrs	Checkbox	Check this box if your title is Mrs. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Title - Miss	Checkbox	Check this box if your title is Miss. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Title - Ms	Checkbox	Check this box if your title is Ms. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Title - Mx	Checkbox	Check this box if your title is Mx. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Q6 Title (honorific)	Text	Enter the title or honorific you use (for example Mr, Mrs, Miss, Ms, Mx or Other). Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Q6 Family name (surname)	Text	Enter your family name or surname exactly as it appears on official documents. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'. Max length: 40 characters
Q6 First given name	Text	Enter your first given name (your primary personal name) as shown on official records. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.
Q6 Second given name	Text	Enter your second given name or middle name if you have one; leave blank if none. Fill only if 'Q4 - Yes (can afford to repay)' is 'Yes'.

Claim for Special Employment Advance (SU514) Instructions