Step 1 of 6 16% Given Name*Surname*Date of Birth* Gender*MaleFemaleAddress*Language Spoken at Home*Phone Number*Email Address* Customer Reference Number (CRN)*PRODA Registration Authority Number (RA):*ABN* Do you hold or actively working towards qualification in Children’s Services?*YesNoFamily Day Care HistoryDo you have experience in Family Day Care?*YesNoName of Famly Day Care Service*Start Date At Service* Still Registered With Service*YesNoEnd Date* OTHER CHILD CARE EMPLOYMENT HISTORY Please list previous occupation, workplaces and the dates you were employed. ORGANISATIONROLE/POSITIONCurrently Working?YESNOStart DateEnd Date Do you own your home?*YesNoPlease Attach Evidence Of Landlords Written Approval Drop files here or Number of Adults residing in home over the age of 18 years*0123Adult 1 Full Name*Adult 1 Gender*MaleFemaleAdult 1 Date of Birth* Adult 1 Relation to Educator*Adult 1 Place of Employment*Adult 2 Full name*Adult 2 Gender*MaleFemaleAdult 2 Date of Birth* Adult 2 Relation to Educator*Adult 2 Place of Employment*Adult 3 Full name*Adult 3 Gender*MaleFemaleAdult 3 Date of Birth* Adult 3 Relation to Educator*Adult 3 Place of Employment*Number of Children residing in home under the age of 18 years*0123Child 1 Full name*Child 1 Gender*MaleFemaleChild 1 Date of Birth* Child 1 Relation to Educator*Child 2 Full name*Child 2 Gender*MaleFemaleChild 2 Date of Birth* Child 2 Relation to Educator*child 3 Full name*Child 3 Gender*MaleFemaleChild 3 Date of Birth* Child 3 Relation to Educator* REFERENCES Please Provide Details of atleast Two References Referee 1 Name of Organisation*Referee 1 ROLE/POSITION*Referee 1 Contact Name*Referee 1 Contact Number*Referee 2 Name of Organisation*Referee 2 ROLE/POSITION*Referee 2 Contact Name*Referee 2 Contact Number* Key Selection Criteria Questions Please answer the following questions with as much information as you can. What is the role of an educator in facilitating children’s learning?*What is your understanding of the National Quality Standard and Early Years Learning Framework?*Please detail how you have maintained a safe, organised and hygienic environment?*What risks to children are present in your home, both inside and outside and what control measures you have taken to eliminate the risks?*Please detail your understanding of children’s development?* A comprehensive safety check will be undertaken when the applicant has successfully undertaken the Orientation course and we will provide you with the list to rectify for safety of children. All glass accessible to children, 1.00 meter or less above floor level, must be safety glass or treated with a Product from shattering if broken.Do you have an enclosed back yard?*YesNoAre you on a rural property?*YesNoDo you have any shade provision?*YesNoDo you have any pets?*YesNoPlease list breed and type of pets N.B. Pets must be kept separate from the children at all times. This is in accordance with Family Day Care policy. How do you plan to keep your pets separate from Family Day Care Children? Please Comment:*Do you have any swimming pool, spa, water pond or any water feature?*YesNoHow do you plan to keep pool, pond , water feature or spa inaccessible during operation of family day care? Please Comment:*Swimming pools , spa , any water pond, water feature must be inaccessible and separate from the children at all times. This is in accordance with Family Day Care policy. How do you plan to keep pool, pond , water feature or spa inaccessible during operation of family day care? Please Comment:Do you have any firearms/ ammunition stored in your home?*YesNoIn the past 10 years have you, or any member residing in your family day care home, been charged and/or convicted of an offence or have any charges currently pending?*YesNoDo you or any member in your home smoke?*YesNoFamily Day Care is to be offered in a smoke-free, alcohol free environment, in both the home (inside and outside) and car. Have you discussed this with all members of your household? Please comment:*Do you have sufficient car space to transport children to school/kindergarten?*YesNoWhat schools and kindergartens are you able to service?*Are you prepared to walk children to school/kindergarten?*YesNo Checklist of Required Documents:ResumeYesNoResume Upload Drop files here or Qualification*YesNoQualification* Drop files here or Working with Children Check of yourself and all members of your home over 18 years old*YesNoFile Drop files here or National Police Check*YesNoFile Drop files here or Current driver’s licence? Victorian driver’s licence number:*YesNoFile* Drop files here or Licence Number*Do you have the use of a car? If YES, how often?YesNoHow often you use car*Do you hold a current First Aid certificate (HLTAID004 Provide an emergency first aid response in an education and care setting)*YesNoFile* Drop files here or CPR renewal*YesNoFile* Drop files here or Child Protection Certificate*YesNoChild Protection Certificate* Drop files here or Food Handling Certificate*YesNoFood Handling Certificate* Drop files here or Public Liability Insurance*YesNoPublic Liability Insurance* Drop files here or Medical Report*YesNoMedical Report* Drop files here or Compliance History Statement*YesNoCompliance History Statement* Drop files here or Declaration: By submitting this form I declare that: * The information contained in this application is true and correct * If I am successful in my application and any of the information provided in this form changes, I will notify Little Tinkers Family Day Care immediately* I Agree This iframe contains the logic required to handle Ajax powered Gravity Forms.
