Educator Application Form – Baulkham Hills Family Day Care

Prospective Educator Details

Name*

First Last

Address*

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code

Phone

Mobile*

Email*

Date of Birth*

Primary Language*

Other Language/s (if any)

Country of Birth*

Current Occupation*

Other People Residing at the Premises

Partner's Details

Full Name	Date of Birth	Phone/Mobile	Occupation	Country of Birth	Works Fulltime? (Y/N)

Child/ren's Details (under 18 years old)

Full Name	Date of Birth	Where is the majority of their time spent during the day (e.g. home, childcare, school etc).

Adult/'s Details (over 18 years old)

Full Name	Date of Birth	Relationship to you (e.g. father, mother, brother etc).

Details about Family Day Care Premises

Please note that a Family Day Care premises must have access to inside and outside play areas, separate sleep area for young children, as well as kitchen, laundry and toilet facilities.

Are the premises rented?*

Yes
No

Please download and complete the Landlord permission form Download Form

Please upload or provide a hardcopy of the completed Landlord permission form

Does the premises have a pool?*

Yes
No

A swimming pool compliance certificate is required. Please upload or provide hardcopy

Does the premises have a fully fenced backyard?*

Yes
No

Appropriate fencing will be required

Are there any pets that reside at the premises?*

Yes
No

Is there a separate area for pet/s on the premises?*

Yes
No

Availability for Family Day Care

Please indicate days/hours of operation and age of children below.

What type of Family Day Care service do you want to provide?*

For under school age children
For school age children
Both under school age and school age children

Days and hours of operation*

Add Hours

Prospective Educator Qualifications and Experience

Do you have an Early Childhood Education and Care qualification?*

Yes
No

Please note that a minimum of Certificate 3 in children services is required to operate a Family Day Care service

Please indicated which qualifications you have*

Cert 3
Diploma
ECT
Working towards qualification
Other

Please specify any other qualifications

Do you have a First Aid qualification? (valid 3 years)*

Yes
No

First Aid qualification expiry*

Do you have a CPR qualification? (valid 1 year)*

Yes
No

CPR qualification expiry*

Do you have an Asthma and Anaphylaxis qualification? (valid 3 years)*

Yes
No

Asthma and Anaphylaxis qualification expiry*

Do you have a paid employment 'Working with Children Check' (WWCC)?*

Yes
No

Please enter your WWCC number*

WWCC qualification expiry*

Please upload or provide hardcopies for ALL of your qualification certificates

Drop files here or

What experience do you have educating and caring for children?*

Do you have any other experience relevant to managing your own business?*

Yes
No

Please elaborate on your business experience*

Have you ever previously been registered as a Family Day Care Educator?*

Yes
No

Name of Provider*

Duration as Educator*

Reason for leaving/stopping*

Please provide details of two (2) referees*

(1) Referee Name	Phone Number	Relationship to Applicant

*

(2) Referee Name	Phone Number	Relationship to Applicant

Additional comments you would like to make regarding your application

Declaration*

By ticking this box I confirm that the information given in this application is true and correct.

I agree to obtain a valid 'Working with Children Check' for myself and all adult household members*

Yes
No

Have you and/or any household member/s been charged with and/or convicted of an offence?*

Yes
No

I have read the 'Prospective Educator Information Pack'*

Yes
No

Please download and read the Prospective Educator Information Pack Download Information Pack

Has the 'Partner of Educator Questionnaire' been completed and provided?*

Yes
No

Please download and complete the Partner of Educator Questionnaire Download Form

Please upload or provide a hardcopy of the completed 'Partner of Educator Questionnaire'

I have read the Educator Role Description and agree to abide by it*

Yes
No

Please download and read the Educator Role Description Download

Are you willing to work in accordance with the Education and Care Services National Regulations & Law, the National Quality Standards and Baulkham Hills Family Day Care policies and procedures?*

Yes
No

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