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Become an Educator with Quest Family Day Care
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Step
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of
12
- Educator Details
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This field is for validation purposes and should be left unchanged.
Name
(Required)
Dr.
Miss
Mr.
Mrs.
Ms.
Prof.
Rev.
Prefix
First
Middle
Last
Are you known by another name?
(Required)
Yes
No
If Yes, please supply
(Required)
Email
(Required)
Mobile
(Required)
Home Phone
Work Phone
Address
(Required)
Street Address
Suburb
Postal Code
Date of Birth
(Required)
DD slash MM slash YYYY
Gender
(Required)
Male
Female
Do you identify as Aboriginal or Torres Islander?
(Required)
Yes
No
Country of Birth
(Required)
Language spoken at home
(Required)
Other languages spoken
Are you a smoker?
(Required)
Yes
No
You must agree to maintain a smoke-free environment while providing care.
(Required)
Yes
No
Do you own the home you intend to use for family day care?
(Required)
Yes
No
Please note that we will require a letter from your landlord as part of your registration process. We can assist you with obtaining this if required.
Do you have a CRN number?
(Required)
This is a Centrelink Reference Number.
Yes
No
If yes, please provide
(Required)
Please provide the details of an emergency contact.
Emergency Contact Name
First
Last
Relationship
Mobile
(Required)
Home Phone
Work Phone
Do you hold at least a Certificate III in Children's Education and Care?
Yes
No
Are you currently undertaking at least a Certificate III in Children's Education and Care?
Yes
No
Do you hold a current Childcare First Aid Certificate?
Yes
No
Do you have a current Anaphylaxis Training Certificate?
Yes
No
Do you have an Emergency Asthma Training Certificate?
Yes
No
Do you have a Western Australia Working with Children Check Card?
Yes
No
Do you have a current Driver's License?
Yes
No
Please list any other qualifications/certificates
Spouse or significant other contact details.
Do you have a spouse/partner?
Yes
No
If yes, please provide name
First
Last
Is your partner/spouse known by any other name?
Yes
No
If yes, please provide name
First
Last
Gender
Male
Female
Date of Birth
DD slash MM slash YYYY
Does the individual live at the same address or stay while care is being provided to children?
Yes
No
Contact Phone Number
(Required)
Do you have children living at home?
No
1 child
2 children
3 children
4 children
5 children
6 children
All members of the household under the age of 18 years old must be included.
Child 1
Child 1 Full Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child 2
Child 2 Full Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child 3
Child 3 Full Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child 4
Child 4 Full Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child 5
Child 5 Full Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child 6
Child 6 Full Name
Date of Birth
DD slash MM slash YYYY
Gender
Male
Female
Child Care Details
Do any of the listed children attend a child care service of any type? If yes, please provide details of regular attendances including name of service and days of attendance.
This includes Long Day Care, Outside School Hours Care, and Family Day Care.
All members of the household over the age of 18 years must have a valid Western Australian Working with Children Check card and a form of photographic ID, ideally a driver’s license.
Name
Date of Birth
DD slash MM slash YYYY
Working with Children
This individual has a WWCC card or is willing to obtain one
Name
Date of Birth
DD slash MM slash YYYY
Working with Children
This individual has a WWCC card or is willing to obtain one
Name
Date of Birth
DD slash MM slash YYYY
Working with Children
This individual has a WWCC card or is willing to obtain one
Name
Date of Birth
DD slash MM slash YYYY
Working with Children
This individual has a WWCC card or is willing to obtain one
Do you have a support person helping you with your family day care?
Yes
No
If yes, please provide the following details for your Educator Assistant:
First
Last
Address
Street Address
Suburb
Post Code
Date of Birth
DD slash MM slash YYYY
Home Phone
Mobile
Work Phone
Working with Children Check
Yes
No
National Police Clearance?
Yes
No
Driver's License?
Yes
No
All persons residing in or regularly visiting the home are required to undergo a Working with Children Check. Visitors who do not frequently visit the home are not generally approved to be in the company of children enrolled in the service (eg. Visitors from overseas/interstate etc.).
Do you have any regular visitors to your home?
Yes
No
Name
First
Last
Relationship
Date of Birth
DD slash MM slash YYYY
Working with Children Check?
Yes
No
Please list your most recent occupation, workplace and date of employment:
Have you ever been employed by or registered with another child care service?
Yes
No
If yes, please provide details:
Have you or any member of your household served any part of a sentence of imprisonment or been convicted of any offence or have any charges currently pending?
Yes
No
Are you willing to work:
Full time
Yes
No
Part time
Yes
No
24 Hour Care
Yes
No
Evening
Yes
No
Weekends
Yes
No
Overnight
Yes
No
OSHC
Yes
No
Care for the maximum of seven children under 13 years of age, including your own, at any one time?
Yes
No
Please indicate the days and times you wish to provide care in week 1:
Monday
(Required)
Start Time
End Time
Tuesday
(Required)
Start Time
End Time
Wednesday
(Required)
Start Time
End Time
Thursday
(Required)
Start Time
End Time
Friday
(Required)
Start Time
End Time
Saturday
(Required)
Start Time
End Time
Sunday
(Required)
Start Time
End Time
Are you prepared to transport / walk children to / from school or kindergarten?
Yes
No
Do you have access to a vehicle for use while providing care to children?
Yes
No
If yes, how many passengers’ seatbelts does the vehicle have?
1
2
3
4
5
6
7
8
9
Declaration
I understand that it is my responsibility to update Quest Family Day Care of any changes to my personal details. I understand that I am self-employed and it is my responsibility to pay my own tax. I understand that it is my responsibility to seek my own clients and that Quest Family Day Care will help market my business to assist in this area. I understand that it is my responsibility to inform Quest Family Day Care of any changes to my child/ren’s care/school arrangements.
Print Full Name
(Required)
Signature
(Required)
Date
(Required)
DD slash MM slash YYYY
The management of Quest Family Day Care undertake to collect, use and store information on this form for the purposes of administering the Service. This information is confidential and will not be disclosed to third parties without your consent, except in specified law enforcement or public health and public safety circumstances.