Your Name (first and last)*
Your Email*
Your Address*
Phone
Work Phone
Mobile*
Emergency Contact*
Emergency Contact Mobile*
Emergency Contact Relationship*
Age*
DOB*
Marital Status*
Nationality*
Are you a citizen of Australia?* YesNo
Do you have children?* YesNo If yes, how many and what ages
Do you smoke?* YesNo
Do you own a car?* YesNo If yes, driver's license No:
Do you have a current First Aid Certificate and CPR Certificate?* YesNo If yes, date of completion Please attach a copy of your certificate
Please provice your AHPRA registration No: Please attach a copy of your registration
Availability / Monday to Friday only* DaysEveningsNights
Do you have any additional relevant qualifications or training? If yes, please provide details
Have you had any serious illness in the last five (5) years?* If yes, please provide details
Do you have current vaccinations for Whooping Cough and Covid-19?* Please provide proof of current immunisation list
Do you have any health issues or disabilities that may affect your ability to perform duties?* If yes, please provide details
Are you currently employed? If yes, what are your Manager/Employer's details:
Professional experience (please tick boxes that relate to your experience) Care of babies 0-3 monthsCare of babies 3-6 monthsCare of babies 6-12 monthsCare of children 1-2 yearsCare of children 2-5 yearsSole charge of children
What is your preference of age group to work with?*
Have you worked with children with a disability/illness/allergy? If so, please give details.:
Please provide preference of days available on weekly basis:*
How did you hear about Mothercraft for Babies?*: Industry/Word of mouthGoogle searchFacebookOther (please specify)
Terms and Conditions
Based on the information/documentation you provide with this Registration form you will be interviewed and reference checked by the Director and Founder of Mothercraft for Babies Beth Barclay at a mutually agreed time.
If successful you will then be provided with the appropriate documentation for casual employment and formally inducted.
A Letter of Engagement will be offered for your agreement and signature.
Please ensure you attach the photocopies of supporting documentation or bring with you to your interview.
Checklist Current driver’s license Nursing Registration documents Current First Aid/CPR Certificate Current Immunisation record eg Whooping Cough/COVID 19 Reference checks (contact details of three relevant 2-3 referees with you at interview) Current Working with Children Check