Name*

Date of Birth*

Address*

Postcode*

Phone*

Mobile

Your Email*

Place of Birth

Language spoken at home

Are you taking any prescribed medication?

Previous / Current Occupation

Qualifications

Do you have any Learning Needs?

Do you have a First Aid Certificate?

Do you have a Working with Children Blue Card?

CPR Certificate?

Childcare experience (including another Family Day Care Scheme)

Do you have any knowledge of Family Day Care?

Do you or any family members that reside at the home have any previous or current Blue Card, Domestic violence, Court orders or child safety issues that we need to know?

Partner's Name / Emergency Contact*

Address*

Phone*

Mobile

Your Email*

Date of Birth*

Place of Birth

Language spoken at home

Previous / Current Occupation

Place of work

Work Phone

Do you have a Working with Children Blue Card?

Details of other occupants of the home

Name*

Date of Birth*

School/Other

All adult occupants of the home, over the age of 18years, are required to obtain a Working with Children Blue Card.

Your Home

Home owner

Style of Home

Rental

Do you have written permission from landlord?

Pets

Details

Is there a separate area the pet/s can go when children are involved in outside play? (regulation requirement)

Fully Fenced Yard

Swimming pool (with locked gate) and suitable fencing

Does anyone in the home smoke? If yes, explain strategies to implement for Family Day Care

Do you have the use of a motor vehicle?

How many seat belts?

Do you agree to obtain a vehicle safety check every 12 months?

Do you have suitable spaces inside and outside your home for the children to play safely? Please explain

Inside

Outside

Where would the children rest/sleep?

Do you have shaded area outside for the children to play? Explain

Details of Care Preferences:-

Full Time

Part Time

Overnight or Weekend

Work hours between am and pm

0-12months:

1-2 years:

2-5years:

School Age:

Special Needs Children:

Children from Different cultures:

Do you agree to have your home address & phone and mobile number displayed on Educator List to other Educators in the Setting ( to only be used for Family Day Care purposes)

Do you agree to receive all correspondence by supplied email address and advise any changes to above address?

Why are you interested in becoming a Family Day Care Educator?

How did you hear about Hatchling House Family Day Care?