Personal Details

Name

Contact Number

Email

Alternate Contact Number

Date of Birth

Address

Gender

MaleFemaleOther/Not specified

Working

Working With Children Card/Number

Expiry Date

Drivers Licence

Copies Attached

WWCCCOVID-19 Vaccination/medical contraindication certificate evidenceDrivers Licence

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Position

Position(S) Applied For

Date Available From

How Did You Learn About The Position?

Education

High School

University / Tafe / Rto

Qualifications

Please Enclose Copies Of All Certificates And Transcripts

Certificates And Transcripts

Certificate III

YesNo

Provide Details

Diploma Level

YesNo

Provide Details

Early Childhood Degree

YesNo

Provide Details

Do You Have A Current First Aid Certificate?

YesNo

Child Protection Course

Course Number

Expiry Date

Approved Anaphylaxis Management Training

Course Number

Expiry Date

Approved Emergency Asthma Management Training

Course Number

Expiry Date

Other Qualifications You Have Acquired

Previous Childcare Service Positions

Provide Details

Previous Employment

Company

Phone Number

Address

Name Of Immediate Supervisor

How Long Have You Been Working / Worked For This Employer?

Describe Your Duties And Responsibilities

I Am Currently Employed At This Company – And It Is Ok To Contact This PersonI Am Currently Employed At This Company - Please Do Not Contact This PersonI Am No Longer Employed At This Company

Reason For Leaving

References

Name

Contact Number

Relationship

Name

Contact Number

Relationship

Name

Contact Number

Relationship

General Questions

What Are You Looking For From This Position?

What Are Your Short-Term Future Goals? (1 – 3 Years)

What Are Your Long-Term Future Goals? (3 – 5 Years)

Other Relevant Information

Prohibition Notice Declaration

This Section Is Designed To Support Approved Providers To Ensure They Do Not Engage Or Employ A Person Who Is Prohibited From Working In An Education And Care Service, In Line With Section 188 Of The Education And Care Services National Law (Acecqa).

Under Section 187 Of The Education And Care Services National Law, A Person Who Is Subject To A Prohibition Notice Is Not Allowed To Work For Or Be Engaged By An Education And Care Service Or Carry Out Any Other Related Activity.

Are You Currently Subject To A Prohibition Notice Under The Education And Care Services National Law?

YesNo

Are You Currently Prohibited Or Restricted From Working With Children Under Any Other Law?

YesNo

Declaration

I Have Read And Understand This Application. I Have Not Withheld Any Information Requested And The Statements I Have Made Are True And Correct. I Understand That Any Omission Or Misrepresentation Of Fact In This Application May Result In Refusal Of Employment Or That Any Subsequent Discovery Of Omission Or Misrepresentation Of Fact May Result In Termination Of Employment.