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Call the HACSU Helpline
1300 88 00 32

Application for HACSU membership

To apply to join HACSU, simply fill in the details on the form below and send the form. The HACSU Membership Officer will be in touch with you shortly to confirm your application.

Application for HACSU membership

	Mr Miss Mrs Ms
Full Name:
Street:
Suburb:
Postcode:
Occupation:
Email Address:
Telephone (home) :
Telephone (work) :
Employer 1:
WorkPlace 1:
Employer 2:
WorkPlace 2:
Employment status :	Full Time Part Time Casual Temporary
If part time hours worked:	under 10 10 to 19 20 Plus

Date of Birth	/ /
If you are a Nurse, Health Professional, Ambulance Officer or Personal Carer you must also complete this section Malpractice, Liability and Legal Benefits Insurance I, the undersigned, being a financial member of the Health Services Union of Australia hereby give notice that I appoint the said Union as my agent for the purposes of giving and acceptance of notices in respect of Malpractice and Legal Benefits Insurance in accordance with the insurance in accordance with the Insurance Contracts 1984 and its Regulations. I also undertake to report circumstances or claims made against me as soon as possible to the said union.
Name:

Your information will be kept strictly confidential and will not be passed on to any other organisation or used for any other reasons.


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