Company REGISTRATION FORM FIRST NAME * LAST NAME * EMAIL * MOBILE * STREET * CITY * STATE * POSTAL CODE * COUNTRY * Afghanistan Åland Islands Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia, Plurinational State of Bonaire, Sint Eustatius and Saba Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Côte d'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands (Malvinas) Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Haiti Heard Island and McDonald Islands Holy See (Vatican City State) Honduras Hong Kong Hungary Iceland India Indonesia Iran, Islamic Republic of Iraq Ireland Isle of Man Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati Korea, Democratic People's Republic of Korea, Republic of Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macao Macedonia, the former Yugoslav Republic of Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Mariana Islands Norway Oman Pakistan Palau Palestinian Territory, Occupied Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Barthélemy Saint Helena, Ascension and Tristan da Cunha Saint Kitts and Nevis Saint Lucia Saint Martin (French part) Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Sao Tome and Principe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Sint Maarten (Dutch part) Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Sudan Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syrian Arab Republic Taiwan, Province of China Tajikistan Tanzania, United Republic of Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Venezuela, Bolivarian Republic of Viet Nam Virgin Islands, British Virgin Islands, U.S. Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe CURRENT LOCATION? CURRENT LOCATION? COUNTRY OF ORIGIN * DATE OF BIRTH: DD/MM/YYYY * My Ideal Family WHAT POSITION ARE YOU LOOKING FOR? * AU PAIR AU PAIR - MALE LIVE IN NANNY LIVE OUT NANNY - PART TIME LIVE OUT NANNY- FULL TIME CASUAL NANNY / BABYSITTER AFTER SCHOOL CARE WORK OVERSEAS DATE AVAILABLE * Select Date Inmediate Select Notice Period YYYY-MM-DD (eg. 2019-01-01) IDEAL START DATE * IDEAL CONTRACT LENGTH * Long Term / Permanent 1 year 6 months 3-6 months Temp Unsure * ARE YOU ON/ WILL YOU BE ON A VISA * NO – I’M A PERMANENT RESIDENT OF AUSTRALIA YES – PLEASE ADVISE WHICH VISA TYPE VISA TYPE * - Working Holiday Student Unsure Please ensure you are eligible for a Visa to allow you to legally work in Australia before continuing with your application Immigration Website VISA EXPIRY DATE * WILL YOU BE STUDYING? * YES NO IF YES, PLEASE ADVISE WHERE AND WHEN YOU STUDY AND YOUR AVAILABILITY TO WORK * LOCATIONS IN WHICH YOU WANT TO WORK? * Queensland (Brisbane/Cairns/Gold Coast/Sunshine Coast etc.) New South Wales (Sydney / Bondi / Blue Mountains) Victoria (Melbourne etc.) South Australia (Adelaide etc.) Western Australia (Perth / Darwin) Northern Territories Flexible/ Any location / I don't mind CAN YOU DRIVE? (PLEASE SELECT NO IF YOU ARE NOT WILLING TO DRIVE IN AUSTRALIA) * YES NO IF YES, HAVE YOU DRIVEN IN AUSTRALIA? * YES NO DO YOU HAVE YOUR OWN CAR? * YES NO About Me PLEASE WRITE A BRIEF INTRODUCTION ABOUT YOURSELF, YOUR SITUATION AND YOUR IDEAL FAMILY ROLE * CHILDCARE EXPERIENCE PLEASE DESCRIBE ANY PREVIOUS EXPERIENCE YOU HAVE WORKING WITH CHILDREN. PLEASE LIST INC. AGE OF CHILDREN, DURATION OF EACH JOB & TASKS CARRIED OUT * I AM EXPERIENCED CARING FOR THE FOLLOWING * Babysitting Casual Nannying Tutoring / Coaching Experienced Nanny (over 2 yrs) Childcare Professional OTHER Housekeeping DESCRIBE YOUR EXPERIENCE LEVEL * Newborns / Infants Toddlers Kindy / pre School Primary School Teenage Twins / multiple Household Management HOMEWORK SUPERVISION * WILLING TO LEARN EXPERIENCED NOT INTERESTED COOKING FOR FAMILY * WILLING TO LEARN EXPERIENCED NOT INTERESTED PARENT LAUNDRY * WILLING TO LEARN EXPERIENCED NOT INTERESTED PET DUTIES * WILLING TO LEARN EXPERIENCED NOT INTERESTED AMILY MEAL PREPARATION * WILLING TO LEARN EXPERIENCED NOT INTERESTED PREPARE SCHOOL LUNCHES * WILLING TO LEARN EXPERIENCED NOT INTERESTED GROCERY SHOPPING * WILLING TO LEARN EXPERIENCED NOT INTERESTED My Health DO YOU HAVE ANY HEALTH OR MEDICAL CONDITIONS? * YES NO IF 'YES' PLEASE EXPLAIN DO YOU TAKE ANY PRESCRIBED MEDICATION? * YES NO ARE YOU HAPPY TO OBTAIN A MEDICAL CERTIFICATE FROM YOUR DOCTOR? * YES NO PLEASE LIST ANY ALLERGIES DO YOU HAVE DIETARY REQUIREMENTS? * YES NO IF YES, PLEASE SPECIFY Vegetarian Vegan Gluten Free Lactose Intolerant Other DO YOU SMOKE? * YES NO SOCIAL / OCCASIONAL SMOKER ARE YOU FULLY VACCINATED ? * YES NO - BUT I AM HAPPY TO UPDATE VACCINATIONS IF REQUIRED NO - I DO NOT WANT TO BE VACCINATED UNSURE Checks DO YOU HAVE A CURRENT POLICE CHECK? * YES NO UNSURE OTHER FIRST AID * YES NO AUSTRALIAN WORKING WITH CHILDREN CHECK ? * THIS IS A LEGAL REQUIREMENT TO HAVE APPLIED BEFORE STARTING TO WORK WITH CHILDREN * YES NO UNSURE CPR * YES NO Please provide contact details for 2 references - at least one to be childcare related REFERENCE 1 NAME * REFERENCE 2 NAME * REFERENCE 1 CONTACT PHONE/EMAIL * REFERENCE 2 CONTACT PHONE/EMAIL * Please attach any supporting documents here: References, Cover Letter, Visa Certificates I'm not a robot *
