Workers

Workers

Break in Service Query

Complete the form below and attach the relevant documents as evidence to support your application for an approved break in service.

Personal Details


Interstate Service Documentation

Enter the date range of the service you have accrued with any of the interstate construction industry long service leave schemes.

Please attach at least one Statement of Service from the Interstate Long Service Scheme that falls within the disputed period.

Medical Incapacity Documentation

Enter the date range for your medical incapacity. If your medical incapacity is ongoing, please enter today's date as the end date.

Please attach either a Doctor's Certificate or Doctor's Note for each of the below years that covers the disputed period.

An 'approved break of service' due to medical incapacity can link two separate blocks of service together as one continuous block - it does not credit your record with any further service.

Self Employed Subcontractor Documentation

Complete the below form with the details of the business which you operate(d) as a subcontractor performing construction trade work in Victoria.

Enter the date range for the duration of your time operating as a self employed subcontractor in Victoria. If you are still operating in this capacity, please enter today's date as the end date.

Please attach the Taxable Income Page from your Tax Return that falls within the disputed period.

An 'approved break in service' due to self employment as a subcontractor in Victoria can link two separate blocks of service together as one continuous block - it does not credit your record with any further service.

Work Cover Documentation

Enter the date range of your Work Cover claim, from the date the injury occurred to the date you were signed off to return to work.

Please attach your Certificate of Capacity from WorkCover for each of the below years that covers the disputed period.

Work Cover service credits can be added to your service record up to a maximum of 240 days per injury.

Please note, to claim a long service leave entitlement, a member must have accrued a minimum of seven years continuous service. To check if you have an available entitlement or if an 'approved break in service' may make you eligible to claim an entitlement, please log into our online services where you can view your service record.

* Indicates mandatory field