Name *

First Name

Last Name

Home Address *

Please provide your ENTIRE address, including postcode & state.

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Are you legally entitled to work in Australia? *

Yes

No

Which days do you plan to operate your Family Day Care service? *

Select all that apply

Monday

Tuesday

Wednesday

Thursday

Friday

Saturday

Sunday

Do you rent your home? *

If you are renting, please include a letter from your landlord, authorising you to do Family Day Care from your home. If needed, information about Family Day Care is available from Foundations Family Day Care. Please call 0421 599 416.

Yes

No

Do you have pets? *

Yes

No

Do you have current First Aid and CPR training? *

Yes

No

Do you have current Working With Children Checks and Police Checks for everyone over 18 who lives in your home? *

Yes

No

Are you or have you ever been subject to a prohibition or suspension notice under the Education & Care Services National Law or the Education & Early Childhood Services (Registration & Standards) Act 2011? *

Yes - please provide details below

No

Have you ever held or applied for a licence, approval, registration, certification, or other authorisation under the National Law which the regulatory authority refused, refused to renew, suspended, or cancelled (for example, as a nominated supervisor, a person in day-to-day charge, a person with management or control)? *

Yes - please provide details below

No

Were you formerly registered with another approved provider? If yes, please list service details (including full name of service) and the reason(s) you left your previous role(s). *

Yes - please provide details below

No

I certify everything in this application is true and correct. *

I agree

I am aware that I may be subject to penalties under a Commonwealth or State or Territory Act if I provide false or misleading information. *

I agree