NSW Nomination Application Form R Skilled Regional (Provisional) visa (subclass 489) Nominating region SkillSelect EOI Number Title: Last Name (as shown on passport): First Name (as shown on passport): Date of birth Age: Country of Birth: Citizenship: No. of (DD/MM/YYYY): Dependents: Passport No.: Australian Visa Held (if any): Expiry Date: Address: Tel No (incl. country code): Email: NOMINATED OCCUPATION Nominated Occupation ANZSCO Code ENGLISH LANGUAGE TEST RESULT (IELTS or OET) Listening Reading Writing Speaking Overall EDUCATIONAL QUALIFICATIONS (for which you are claiming points) Qualification Course Date Completed Name of Institution SKILLED EMPLOYMENT (for which you are claiming points) Occupation Employer Dates of employment From To Australian skilled employment Overseas skilled employment
NSW Nomination Application Form R Skilled Regional (Provisional) visa (subclass 489) Nominating region SkillSelect EOI Number Title: Last Name (as shown on passport): First Name (as shown on passport): Date of birth (DD/MM/YYYY): Age: Country of Birth: Citizenship: No. of Dependents: Passport No.: Australian Visa Held (if any): Expiry Date: Address: Tel No (incl. country code): Email: NOMINATED OCCUPATION Nominated Occupation ANZSCO Code ENGLISH LANGUAGE TEST RESULT (IELTS or OET) Listening Reading Writing Speaking Overall EDUCATIONAL QUALIFICATIONS (for which you are claiming points) Qualification Course Date Completed Name of Institution SKILLED EMPLOYMENT (for which you are claiming points) Occupation Employer Dates of employment From To Australian skilled employment Overseas skilled employment
Form-R_September-2014.docx