Nanny Application Form 1 Personal Information2 Qualifications and Certifications3 Availability4 Preferred Serivce Location5 Health and Wellbeing6 Career Experience7 Confidence and Experience8 Team Leadership Skills9 References10 Disclosure Personal InformationName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code Date of Birth* Home PhoneMobile Phone*Email Address* Enter Email Confirm Email Drivers License No*License Expiry Date* Privately Owned Vehicle Use*Would you be prepared to use your car for during work hours?YesNoEmployers Vehicle Use*Are you prepared to drive an employer’s car?YesNoCar Type*Automatic OnlyManual OnlyBothPlease Upload your a Photo of Yourself*We will need a photo of you for your Profile that we send to prospective clients. Please upload photo with a White background and include the shoulders we can crop the photo for you. Emergency ContactName* First Last Address* Street Address City State / Province / Region ZIP / Postal Code PhoneWork PhoneMobile Phone* Qualifications and CertificationsDo you have a New Working With Children Check Number?*If No, you are required to obtain before working with children. YesNoWorking With Children Check Number*By Law you must have a current Working with Children Check or if you dont have a check please enter "WILL APPLY"Qualifications HeldEnter as many rows as required to list all your Qualifications and Certifications. Click the 'Plus' sign to add new rows.Qualification / CertYear AchievedExpiry (type n/a if none) A condition of contract work with Sapphire Coast Nannies all our carers are required to have up to date first aid certificates. Sapphire Coast Nannies can provide you with details of upcoming First Aid Courses in your area to undertake.First Aid Certificate*Do you have a current First Aid Certificate?YesNoExpiry Date*When does your First Aid Certificate expire? Upload First Aid Certification*Please upload a copy of your First Aid Certfication. Please Not the require First Aid Code is HLTAID004 Provide an emergency first aid response in an education and care setting.Child Care Employed?*Are you currently employed in the child care industry?YesNoPosition Held*Job Network Agency*Are you registered with a Job Network Agency? (E.g. Mission Australia, Campbell Page)YesNoWhat Agencies?Please list names of Agencies. One on each line.Preferred Method of CommunicationContact Channel*For upcoming Jobs what would be your preferred method of Communication? (ie: phone, mobile, email, facebook, sms, etc..) Phone / MobileEmailFacebook AvailabilityPlease ensure we are constantly informed of your availability, or changes to your circumstances. Casual Nannies let us know each week that you wish to your availability for babysitting Jobs. Feel free to call text or email your availability regularly.Service*Please indicate what services you are interested in. Choose as many as you like. Casual Permanent Full Time Evening Babysitting Before & After School Care Holiday Help Event Care - Weddings AvailabilityPlease provide times or All Day or NightsMondayTuesdayWednesdayThursdayFridaySaturdaySunday Ideal Situation* In a perfect world what would be the perfect work for you?Your initial application form will give Sapphire Coast Nannies an overview of your areas of service of expertise as well as an indication of your availability for work with the agency and families in the area. To ensure our Availability Database is kept up to date you are required to submit your availability on a regular basis by contacting the office by phone, email or via text message. Please ensure your availability details remain current at all times. If there is any change to your availability you are advised to contact the office immediately. It is not the responsibility of Sapphire Coast Nannies to follow up on your availability. In order for work to be assigned your availability must be known. For Casual Carers we ask that you contact us via text message or phone between Wednesday and Friday of that week if you wish to work Friday and/or Saturday Babysitting jobs.OtherIs there anything else we need to know? Preferred Service LocationTick what areas you are prepared to work in.Illawarra Coledale Thirroul Bulli Corrimal Fairy Meadow Wollongong Port Kembla Wingdang Warrilla Kembla Grange Dapto Albion Park Shellharbour Minnamurra Kiama Jambaroo Shoalhaven Bangalee Basin View Bawley Point Berrara Berry Bewong Bomaderry Broughton Vale Burrill Lake Callala Bay & Beach Cambewarra Conjola Coolangatta Culburra Beach Currarong Depot Beach Dolphin Point Erowal Bay Greenwell Point Huskisson Hyams Beach Jaspers Brush Kangaroo Valley Lake Conjola Manyana Milton Mollymook Myola Narrawallee North Durras Nowra Old Erowal Bay Orient Point Pyree Sanctuary Point Shoalhaven Hds St.Georges Basin Sussex Inlet Swan Haven Tabourie Lake Tapitallee Terara Tomerong Ulladulla Vincentia Wandandian Woollamia Worrigee Eurobodalla Batemans Bay Bodalla Broulee Central Tilba Mogo Montague Island Moruya Narooma Nelligen South Durras Tilba Tilba Tuross Head Sapphire Coast Bega Bemboka Bermagui Brogo Candelo Cobargo Eden Merimbula Pambula Southern Highlands Tathra Wydboyn Wyndham Southern Highlands Berrima Bowral Bundanoon Burrawang Canyonleigh Exeter Fitzroy Falls Mittagong Moss Vale Penrose Robertson Sutton Forest Wingello Canberra Belconnen Canberra City Gungahlin North Canberra South Canberra Tuggeranong Valley Western Creek Woden Valley Health & WellbeingDisabilities or Handicaps*Do you have any disabilities or handicaps that would prevent you from performing specific tasks? YesNoMental Health*Have you, at any time, suffered from mental or physical health problems, which could affect your ability to work as a nanny with sole charge of children? YesNoPhysical Limitations*Do you have any physical limitations?YesNoAllergies*Do you have any allergies?YesNoProvide DetailsIf you answered yes to any of the above, please provide details for each item. Career ExperienceExperience*Actual child care years experience.Preferred Age*Preferred age group you would like to work with.Age GroupWhat ages have you had experience with? Not including your own children. Select all the apply. Newborns 6 - 24 months 2 – 5 years 6 – 12 years Teenagers Children with Disabilities and Special Needs Experience with special needs or disabilitiesPlease state type of special needs or disabilities you have had experience with e.g. Autism or cerebral palsy. Confidence and ExperienceSole charge*YesNoDriving Children to Activities*YesNoPreparation of Meals/Snacks – ChildrenYesNoPreparation of Dinners for FamilyYesNoParticipation in family outings / vacationsYesNoBathing of childrenYesNoPetsYesNoGeneral ErrandsShopping, etcYesNoCleaning of children's area(s)Shopping, etcYesNoLaundryChildren onlyYesNo Team Leadership SkillsManagement SkillsDo you have experience directing a team?YesNoStrengths*Please describe your management strengths.WeaknessesPlease describe your management weaknesses. ReferencesTwo Work Related References*We require at TWO Work Related References. Click the 'Plus' sign to add rows as required. Contact NameContact Phone NumberCentrePositionChildren’s Age Groups worked withBrief Description of Position held and duties Two Personal References (not Family members)*We require at least TWO Personal References. Click the 'Plus' sign to add rows as required. Must not be relatives. Contact NameContact Phone NumberRelationshipHow long have you known them If you are new to working in the Informal and in-home Child Care Sapphire Coast Nannies will require two personal references to attest to your character and experience with children. Include written references with your resume.It is a condition of employment that all staff carers maintain and take their portfolios with them on all bookings. This portfolio contains important documentation which may be required whilst on a booking; including administration of medication forms, incident report forms, transportation and timesheet documentation. DisclosureI release Sapphire Coast Nannies to contact the references that I have provided above and acknowledge that the information gained from these references will be provided to families working with Sapphire Coast Nannies for placement.I understand that it is Sapphire Coast Nannies policy that no individual will be discriminated against because of race, religion, gender, sexual orientation, national origin, age, marital status, disability, or any other basis prohibited by law. We will consider all individuals for any position for which they are qualified and able to perform.By submitting my completed form below I verify my understanding of the following: Sapphire Coast Nannies does not guarantee placement of any nanny.Sapphire Coast Nannies reserves the right to reject a nanny for any reason, not prohibited by law, at any time. In order for a nanny to be placed, they will be required to participate in a series of interviews, complete a thorough background check, and a screening involving the contact of at least three child-related references.Please Upload your Resume in DOC or PDF FormatName* First Last Agreement*By selecting YES and submitting this form you certify that all the information provided are true and that I agree to be bound by the terms set forth in the enclosed Terms and Conditions for Nannies. Yes. I understand these provisions and agree to the Terms outlined above. PhoneThis field is for validation purposes and should be left unchanged.