Participation Activity Record form - Department of Human Services

Participation Activity Record
You should use this form to keep a record of your jobsearch efforts and/or activities as outlined in your Employment Pathway Plan/Individual
Participation Plan for the period shown below as we may ask you to provide this information at any time. You should complete this form when you
look for work or participate in an approved activity. If you participated in more than 2 approved activities, provide the details in question 6 or on a
separate sheet. Once this form is filled in, if you still need to record more jobsearch efforts or activities, you can start a new Participation Activity
Record or record the details on a separate sheet. You do not have to complete the following information for any time during this period that you had
an exemption.
1 Your full name
Your Centrelink Reference Number
2 For the period:
From
/ / To / /
3 You are required to look for jobs per fortnight and bring this completed form to your next appointment on / /
4
During this period did you participate in an approved activity?
No
Yes
Go to next question
Approved activity name Date started activity Date stopped activity
1
/ /
/ /
2
/ / / /
Hours per
fortnight
5 If you had a requirement to look for work you should record your job contacts below. We may contact employers to verify details.
Employer’s business name
Contact number Type of job Method of contact Date of contact
1
( )
/ /
2
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/ /
3
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4
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Continued
Employer’s business name
Contact number Type of job Method of contact Date of contact
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28 ( ) / /
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6
Notes/Referrals/Activities (include appointments, other activities or things you may wish to record including any issues you may have had)
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