Académique Documents
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489
Yes
No
Yes
No
Are you currently working in your nominated skilled occupation in the NT?
Yes
No
Yes
No
Yes
No
Yes
No
Yes
No
What are your reasons for applying for NT nomination? Please detail.
1.2 Education (only complete this section if you have studied in Australia)
Have you ever studied in Australia?
(If yes, please provide details below)
Name of institution
Location of
campus
Course
undertaken
Award received
Date completed
Department of Business
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
1.3 Australian skill assessment
Have you completed an Australian skills assessment?
Yes
No
Date of assessment
What is the title of your nominated occupation?
What is the ANZSCO Code for your nominated occupation?
Refer to the Department of Immigration and Border Protection Consolidated Skilled Occupation List
available online at http://www.border.gov.au/Trav/Work/Work/Skills-assessment-and-assessingauthorities/skilled-occupations-lists/CSOL
Yes
http://www.border.gov.au/Trav/Work/Skil
No
Mr
Mrs
Ms
Miss
Other
Family name
Given name(s)
Date of birth
Age
Current
occupation
Country of birth
Country of
citizenship
3.2 Address
Street number
Street
name
City / Town
Postal code
Country
Telephone
Work
Home
Mobile
Email address
3.3 Dependants
How many people are included in your application? (Please provide full family details below)
Department of Business
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
Relationship
Full name
Gender
Date of birth
(Male / Female)
Darwin
Katherine
Nhulunbuy
Tennant Creek
4.3 Contacts
Have you made contact with anyone in the location that you have identified?
(If yes, please provide name and details of contact. You may also wish to attach further
information regarding your contact with employers, for example, copies of emails,
outcomes of discussions)
Yes
Organisation
Contact details
No
Contact
number
Relationship to
yourself
(e.g. 08 8951
7777)
(e.g. Sister /
Friend)
Yes
No
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
Do you have any friends or relatives elsewhere in Australia?
(If yes, please indicate their relationship to you and where they live. Relatives must be
related by blood or marriage)
Contact
number
Relationship to
yourself
(e.g. 08 8951
7777)
(e.g. Sister /
Friend)
Yes
No
4.6 Relocation cost of living and financial resources (This information is only required from
applicants who are not currently living and working in the NT)
Yes
No
4.8 Employment
Have you received an offer of employment from a NT employer?
(If yes, please attach a copy of the offer of employment and provide details of a company
contact)
Company
Yes
No
Contact information
Yes
No
Yes
No
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Subclass 190 and 489 Nomination Application Form
If so, are you licensed and / or registered?
Yes
No
Yes
No
Department of Business
Date
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Declaration
I _______________________, hereby declare that the details provided within this application,
including supporting documents, are true and correct to the best of my knowledge and belief and I
undertake to inform the Northern Territory Government of any changes therein, immediately.
If information within this application, including supporting documents is found to be false, untrue,
misleading, or misrepresenting, I agree that the Northern Territory Government may forward any
evidence to the appropriate Commonwealth and/or State or Territory Government agencies for
further investigation.
If I have engaged a migration agent to represent me, I acknowledge that my application, including
supporting documents, has been provided with my full knowledge and consent.
Signature of Applicant:
Name of Applicant:
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
use the information provided in this application to make necessary inquiries with any
person, association, business or governmental agency to verify claims provided in the
application in order to establish identity, qualifications, experience and residency and
authenticate documentation
retain my application and supporting documents in accordance with Northern Territory
Government policies and standards
share the information provided with the Third Parties described above
utilise the information contained in my application and supporting documents to undertake
research and inform surveys
Signature of Applicant:
Name of Applicant:
Lodgement of applications
Applications for Northern Territory Government nomination should be forwarded by email to:
migration@nt.gov.au
Contact details
For further information about our programs contact:
Migration NT
Outside Australia: (+61) 8 8999 5264
Inside Australia: 1800 006 282
Email: migration@nt.gov.au
Department of Business
Skilled Nominated (Subclass 190) visa and Skilled Regional (Subclass 489) visa Subclass
Northern Territory Government Nomination Checklist for Visa Subclasses 190 and 489
Completed NT Government nomination application form
Evidence of SkillSelect EOI number issued by DIBP SkillSelect System
http://www.border.gov.au/Trav/Work/Skil
* This information is not required from applicants who are already living and working in the NT.
Please note that failure to supply a completed application at time of submission will result in your
application being rejected as incomplete.
Please note that this information may be aggregated to produce statistical information and for
departmental purposes. These statistics do not identify individuals or their personal circumstances.
Department of Business