Building & Staff Car Park Access Application Form

Employer

Position

Phone

Mobile Phone

Email(Required)

ASIC Number

Expiry Date

Rego #1

Eight (8) Digit Code

Four (4) Digit Code

Aircraft Registration:

Employer to complete this section (not applicable for ga gate 23 swipe card)

I (name)

of (company):

certify:

Terms & Conditions

I understand that I am responsible for the use of the security access allocated to me or registered to me, and that the security access is not to be given to any other person (unless it is a multi-user key and has been disabled first). I understand that Gladstone Airport Corporation (GAC) can disable my security access at any time. I will return any security access devices and/or car park access cards to GAC IMMEDIATELY upon no longer having an operational need to possess the security access. Airport employees are entitled to free day parking only whilst engaged in direct employment activities by their respective Employer at Gladstone Airport, during operational hours. Parking for personal travel purposes is not permitted.

An administration fee of $40.00 per access card will be charged for the replacement of lost permits.

Signature

Date

Welcome to

Gladstone Airport

Your gateway to the Gladstone Region

Security & staff car park access application form