Baw Baw Family Day Care Educator Application Form

Baw Baw Family Day CareEducator Application FormPrivacy StatementThe personal & health information requested on this form is being collected by Council to meet its duty of care requirements, to informcare provider selection, for accountability to the Department of Family & Community Services and for the Australian GovernmentCensus of Child Care Services. The personal information will be used solely by Council for that purpose or directly related purposes. Ifthis information is not collected the application cannot proceed. The applicant may apply to Council for access to/, and/ or amendmentof, the information. Requests for access and/or correction should be made to Council’s Privacy Officer, Mrs Robyn D’Arcy ontelephone : 5624 2411Name of Applicant:________________________________________________________Address:_________________________________________________________________PostalAddress:_________________________________________________________________Postcode:_______Telephone:____________________Mob:_______________________Date of Birth:_________________________Australian Business No.(ABN)____________________________________________Working With Children Card No.(WWCC) ________________________________Email_____________________________________________________________________Are you 18 years of age or above? Yes No(Education and Care Services National Regulations requires Educators to be 18 years orover)Country of Origin:________________________________________(The Australian Government Family Day Care Census requires the provision of details ofyour Country of Origin)Language /s spoken:_____________________________________(The Australian Government Family Day Care Census requires the provision of details oflanguages spoken)Other persons residing in the home:Name Date of Birth Relationship to Applicant

Next of kin for emergency purposes:Name:__________________________________________________Address_________________________________________________Relationship to applicant:_____________________________________Telephone: BH____________________ AH________________Mobile:_____________________Are you legally entitled to earn an income in Australia?YesNoIs any other business operated from your home?YesNoDo you have a swimming pool or outdoor spa on your property?Yes No Conditions apply regarding Pools.Do you have any Pets? Yes NoPets need to be able to be contained in either a separate yard, cage or area._______________________________________________________________Are you renting your home? Yes NoIf you are renting, please include a letter of permission to operate Family DayCare (Landlord Approval letter). If an explanation of family day care is needed,for your Landlord, this can be supplied by the Family Day Care Coordinatorwho can be contacted on telephone 5625 0216Please indicate the days you are willing to operate your Service(we require a minimum of 3, 8 hour week days per week )Monday Tuesday Wednesday ThursdayFriday Saturday SundayDo you have Certificate 3 in Childcare (min.) Yes No(If not, then a commitment to gaining this qualification is required from you.)Do you have current Level Two First Aid Certificate? YesDo you have current Asthma & Anaphylaxis Training? YesNoNoDo you have current Working with Children Checks andPolice Checks for yourself and other family members overthe age of 18? Yes NoPlease attach copies to this application.

Please provide the details of two Referees that we can contact:Referees: Please note family members by birth or marriage may not be referees.Referee 1:Name: ____________________________________________Telephone: BH ____________________ AH ______________Relationship to applicant________________________________Referee 2:Name: ____________________________________________Telephone: BH ____________________ AH ______________Relationship to applicant________________________________Consent to reference checks:I consent to any reference checks which may be necessary to support this application.I declare the information on this form is true and correct.Signature:_________________________________Date:______________This application can be posted to: Coordinator, Baw Baw Family Day CarePO Box 304, Warragul 3820 or deliver to, the Family and Children's Services building at 23William square Warragul.—————————————————————————————————————Have you attached the Following:Copies of Working With Children ChecksCopies of Police ChecksCopy of Child Care QualificationsLandlords Letter (if relevant)Copy of First Aid CertificateCopy of Anaphylaxis TrainingCopy of Asthma TrainingResume√N:Children and Family Services/Templates/Family day Care/Carer App(Web)/application