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.
Your Centrelink Reference Number
1 Your full name

For the period:

You are required to look for

During this period did you participate in an approved activity?

No
Go to next question
Yes

From

To

jobs per fortnight and bring this completed form to your next appointment on

Date started activity

Approved activity name

Hours per
fortnight

Date stopped activity

If you had a requirement to look for work you should record your job contacts below. We may contact employers to verify details.
Employers business name
Contact number
Type of job
Method of contact
Date of contact
1

10

11

12

13

14

15

16

17

18

19

20

21

22

23

24

25

26

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Employers business name

Contact number

Type of job

Method of contact

Date of contact

27

28

29

30

31

32

33

34

35

36

37

38

39

40

41

42

43

44

45

46

47

48

49

50

51

52

53

54

55

56

57

58

59

60

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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