Form Vl778 - Statement Of Service (Sos) Request Form
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1
2Please return to:
VL778
People and Culture Operations
Updated 10/17
Courier R11/10
GPO Box 1152
Adelaide SA 5001
Ph: (08) 8226 1356
Fax: (08) 8124 4631
Email:
DECD.Recruitmentsos@sa.gov.au
STATEMENT OF SERVICE (SOS) REQUEST FORM
A Statement of Service provides the employee with an accurate record of their employment with DECD. Before completing this form, please refer
to the Guidelines for SOS found on page 2 of this application.
Current DECD employees can request a statement of service through the
Employee Information Kiosk
(EIK).
Once completed, email the form to the Recruitment Unit (email: DECD.Recruitmentsos@sa.gov.au). Please allow up to six weeks for your
statement to be prepared.
NB: If you require information regarding your Long Service Leave (LSL) entitlements do not complete this form. Please contact Shared Services
Ph 8462 1333 and press 1 for Payroll or email:
payroll05@sharedservices.sa.gov.au
Section 1: EMPLOYEE DETAILS
Family Name
Given Name(s)
Previous Surname
Date of Birth
(If applicable)
Change of Name
ID Numbers
Please attach all supporting evidence.
Please list all ID numbers provided by DECD.
(Refer to VL778 Guidelines page 2)
Section 2: CONTACT DETAILS FOR SENDING STATEMENT OF SERVICE
Address
Contact Phone
Postcode
Number
E-mail
Section 3: GENERAL INFORMATION / EMPLOYMENT HISTORY / TYPE OF EMPLOYMENT
*** Please provide an indication of ANY service with DECD:
Indicate which employment sector(s) is /are appropriate to you by placing an X in one or more boxes.
Employment within: Schooling Sector
Preschool Sector
Corporate
Type of employment
Termination Date(s)
Commencement Date(s)
(teacher, ancillary, corporate)
(If applicable)
Please provide reason(s):
Have you ever had a
No
Yes
Details:
break in service?
Please indicate the following
Bonded Student (Training prior to 1979)
Unbonded Student
(if applicable - teachers only):
Optional: Do you require a Statement of Service for Teacher Registration purposes?
No
Yes
Section 4: DECLARATION
By placing an X in the box on the left, I declare to the best of my knowledge that the information I have provided on this
form is true and correct.
Date
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