Secondary reviewpersonal details

Ms Mr Mrs Dr other (specify)

Name:

Department/agency in which employed:

The MPC operates an Electronic Document Records Management System and will use email to communicate in writing with you throughout the progress of and in advising you of the outcome of the Review. For security and privacy reasons it is MPCs preference that you provide your gov.au email address unless you have a reason for using an alternative address.

Your gov.au email address is: gov.au

If not gov.au please explain:

Preferred phone number: Work Personal other (specify)

Alternative phone number: Work Personal other (specify)

Your address:

Please also provide postal address if different to above (the MPC will use post as a last resort means of communication):

Job title and current classification:

On-going classification:

Special requirements to enable participation in this review:

It is your responsibility to advise this office of any changes to these details during the course of the review.

Providing additional information

Please do not attach supporting documents to this application form.

Your agency is required to provide all the relevant documents from the primary review when forwarding your application to this office and, to provide a copy to you. After considering these documents, if there are other relevant documents that have not been included, you may then provide them to this office.

Secondary reviewapplication form

Use this form if you are seeking review:

1. of a decision by your agency that the actions contained in your primary review application were not reviewable, or

1. because you are dissatisfied with the outcome of your agencys primary review.

Applications for secondary review must be submitted to your agency.

Action(s) you are seeking review of:

Date action(s) occurred:

Brief statement about why review is sought:

Outcomes sought:

Case summary (please limit to 2 pages):

Signature:...............Date:..

Privacy

The Merit Protection Commissioner is committed to protecting and maintaining personal information collected by this office in accordance with the Privacy Act 1988. The Merit Protection Commissioners privacy policy and a collection notice detailing how your personal information is collected, used and disclosed is available at our Applications page.

Please note that privacy obligations extend to third parties. That is, where you or your agency provides this office with personal information of third parties, the Merit Protection Commissioner may notify them that their personal information has been collected.

Feedback

Within two months of your review being finalized, we send you an online survey about your MPC review experience. The survey is voluntary and anonymous and the link will be forwarded via email or letter.

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