This form is to be completed for a Hydroponics Industry Employee Approval. In addition to completing this application, a Hydroponics Industry Personal Information Declaration (PID) must be completed. All details must be completed to the best of your knowledge. It is an offence to make a statement that is false or misleading (whether by reason of inclusion or omission on any particular) in any information provided. If you have any doubt about a question please contact the Licensing Enforcement Branch on (08) 7322 3342.
SAPOL use only	ID Card No:	Application Ref:
PERSONAL DETAILS
Family Name	Given Name(s)
Male Female	/ /
Date of Birth	Occupation
Current Residential Address	Post Code	State
Service Address (This is the address any official correspondence will be sent to)	Post Code	State
( )	( )
Home Phone	Work Phone	Mobile
Email
EMPLOYMENT
Please list ANY Hydroponics store(s) where you are employed or intend to seek employment:- (include the name and address of the store and the owner’s details)