Become an Educator with Quest Family Day Care

Step 1 of 12 - Educator Details

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This field is for validation purposes and should be left unchanged.

Name(Required)

Prefix First Middle Last

Are you known by another name?(Required)

Yes

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

Country of Birth(Required)

Language spoken at home(Required)

Other languages spoken

Are you a smoker?(Required)

Yes

You must agree to maintain a smoke-free environment while providing care.(Required)

Yes

Do you own the home you intend to use for family day care?(Required)

Yes

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

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

Are you currently undertaking at least a Certificate III in Children's Education and Care?

Yes

Do you hold a current Childcare First Aid Certificate?

Yes

Do you have a current Anaphylaxis Training Certificate?

Yes

Do you have an Emergency Asthma Training Certificate?

Yes

Do you have a Western Australia Working with Children Check Card?

Yes

Do you have a current Driver's License?

Yes

Please list any other qualifications/certificates

Spouse or significant other contact details.

Do you have a spouse/partner?

Yes

If yes, please provide name

First Last

Is your partner/spouse known by any other name?

Yes

If yes, please provide name

First Last

Gender

Male

Female

Date of Birth

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

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

National Police Clearance?

Yes

Driver's License?

Yes

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

Name

First Last

Relationship

Date of Birth

DD slash MM slash YYYY

Working with Children Check?

Yes

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

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

Are you willing to work:

Full time

Yes

Part time

Yes

24 Hour Care

Yes

Evening

Yes

Weekends

Yes

Overnight

Yes

OSHC

Yes

Care for the maximum of seven children under 13 years of age, including your own, at any one time?

Yes

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

Do you have access to a vehicle for use while providing care to children?

Yes

If yes, how many passengers’ seatbelts does the vehicle have?

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.