Surname: First Name:

Registration – Night Nannies/Mothercraft Nurses

Thank you for your interest in registering with Centenary Nannies and Babysitters. Please
complete the following application form, ensuring that ALL fields are completed. Your personal
details, history and preferences will be recorded in our database. Providing complete information
will give you the best opportunity to be selected for work with our clients. We hope to welcome
you aboard our happy crew of child carers!

Personal Details (Top Section)

Full name
(Company)

Home address Street ____________________________________________________

(Physical address only -
no PO Boxes please) Suburb ___________________________________ Post Code: ______

Contact Type  Child Care Worker

Region  Brisbane  Gold Coast  Sunshine Coast (drop down menu)

(M) (H)
Contact numbers
(add to contact view also)
(W) (FAX)

Email Please print clearly:

Receive regular updates from

us when you provide your __________________________________________________________
email address

(Contact view)  I do not have access to email

 Full Time FT  Mother’s Helper MH

Type of work required
(Please select multiple  Part Time PT  Before/After School Care BSC
categories if applicable)
 Nanny - Qualified NQ  House Manager HM
(Top - Worker Code)

 Nanny - Unqualified NU  Live In LI

BS
 Baby Sitter
Education and Qualifications
Tertiary education  No formal qualifications in child care
(N Tab 1)  Yes (please complete details below)

 Cert. in Child Care Level: Year completed:

Organisation: _____________________________________________

 Diploma in Child Care Level: Year completed:

Organisation: _____________________________________________

 Cert. in Community Services Level: Year completed:

Organisation: _____________________________________________

Other qualifications and certifications

(include type of certification, level, year achieved and organisation)

Level of secondary
education achieved  Year 12  Year 11  Year 10

Are you currently  Yes  No

studying?
What are you studying?

Qualifications (for working specifically with babies)

Please outline Name of degree/qualification
specific qualifications
you have that relate
solely to the care of
infants. i.e –
midwifery, sleep
guidance certificate,
assistance with Where did you obtain this qualification?
‘lactation’ certificate.

When did you graduate from this degree/qualification?

Previous Work History (N Tab 1)

Have you had any experience in the child care industry?

Please include brief details of years worked and centre/agency name – we will refer to your resume work history for further information.

Yes No Babysitting for family and friends BS

 

Yes No Child Care Centres CC (please provide brief details of years worked /centres etc)
 
Dates Child Care Centre

Yes No Other nanny / baby sitting agencies AG (please provide brief details of years worked /agencies etc)
  Dates Agency/private client

Yes No Other relevant work history OT (please provide brief details of years worked and where)
  Dates Agency

How long have you worked within the childcare industry? _________________________________

How long have you worked with babies (other than your own)? _____________________________

What has been your most current role working with babies or in a Mothercraft role?
_______________________________________________________________________________

Can you provide a reference from this most recent role? _________________________________
Your Experience working with Infants
Please indicate next  Newborns. ___________________________________________
to each subject which
best describes your
experience working  6-12 months. _________________________________________
with newborns:
 Sleep guidance. Helping parents establish sleep routines for the
HE- highly baby. _______________________________________________
experienced
 Assistance with lactation. Helping baby to latch or helping mum
SE- Some experience with any feeding problems. ______________________________

NE –No experience  Bathing, dressing and nappy changes. _____________________

or very little
 Post Natal Care. ______________________________________
NC- not comfortable
at all  Assisting mum after a Caesarean birth. _____________________

C – Comfortable  Assistance with settling. I.e. Baby may have wind and need settling
helping clients with and calming. __________________________________________
babies with these
particular subjects.
 Administering medication.________________________________

 Sole charge care of a baby. ______________________________

 Caring for baby multiples. Twins/triplets/quads. _______________

Please indicate any other relevant experience with infants that may help
parents.
Your Preferences (N Tab 1/Ages Cared For)

Please complete ALL questions to help us match you as closely as possible with prospective clients

Office Use: (Ages cared code)

What age groups have you worked with BEFORE:

 Newborns up to 6 months NB
 Infants (6 months to 11 months) INF
 Toddlers (12 months to 3 years) TOD
 4 and 5 year olds PRE
 6 to 12 year olds PRI
 13 years and older SEC
 Twins or triplets MUL
 Groups (please provide info on group size and other info)

What age groups do you PREFER to work with?

 Newborns up to 6 months NB
 Infants (6 months to 11 months) INF
 Toddlers (12 months to 3 years) TOD
 4 and 5 year olds PRE
 6 to 12 year olds PRI
 13 years and older SEC
 Twins or triplets MUL
 Groups (please provide info on group size and other info)
What hours and days are you prepared to work? (also indicate overnights)
Mondays

Tuesdays

Wednesdays

Thursdays

Fridays

Saturdays

Sundays

Other comments/preferences

Medical conditions Do you or any of your children who may accompany you to assignments
have any medical conditions which our agency or clients should know
about? Any condition that may limit you form work. I.e. sore back
therefore no heavy lifting, asthma, food allergies etc

(N Tab 3:Medcon)  No
 Yes (please provide all necessary information)

How did you hear  Our website  Brisbane’s Child  E-Marketing

about Centenary  Internet research  Yellow pages  Newspaper Advert
Nannies?
 School Newsletter  Gumtree.com.au
 Referral (Name & Ph ___________________________________)
 Other
(N Tab 3:Source)
Child Safety Prerequisites (N Tab 2)

Applicants please note that a current Blue Card is mandatory to be eligible for placement with our
clients. When working for the night nanny service and working with Infants First Aid is also
mandatory. If you have an expired one we suggest you renew this to be eligible for any night time
and overnight work caring for babies.
 None  Expired  Yes (provide details below)
First Aid Certification Date obtained: / / Expires: / /
(mandatory)

Training organisation: _______________________________________

Comments:

Blue Card Details Number: Expiry Date: / /

(mandatory)
Name as it appears on card:

Your date of birth (Date, month and year) Age

(N Tab 1)

What is the maximum number of children you would care for at one time?
 1  2  3  4  Depends on ages

General Information (N Tab 2)

Mobility Do you have a current driver’s licence?

(N Tab 2)  No – I rely on public transport

 Yes
Licence No. ____________________
Expiry Date: / /
Type:  Auto and manual  Auto only
Do you have your own car?  Yes  No
Vehicle Registration No. _______________
Make and model of your car? __________________________________
Insurance Policy No. __________________
Expiry date: ___________
Are you willing to drive a client family’s car?  Yes  No

Driving Record Have you ever had your licence suspended or cancelled?  Yes  No

Have you received one or more speeding fines in the last year?
Record any specifics in Gen
Info tab  Yes  No
Do you have Nanny  Yes
Insurance Cover Insurance with: ___________________________________________
Policy no. __________________________ Expiry Date ___/___/___

(N Tab 2)  No, but willing to consider  No, unwilling to obtain coverage

Are you a smoker?
(Mandatory)  Yes  No
(N Tab 2)

Marital status  Married

(Optional)
 Defacto
(N Tab 2)
 Single
 Other
Date of Application
(N Tab 2)

Available From From what date are you available for the above time frames?
(N Tab 2) ______/______/14

How many references

are you supplying?

Next of Kin Name

(N Tab 3)
Relationship to you
Phone contact(s)
Address
Interviewed by  Kristy  Laura
(N Tab 3)

Have you worked with children who have particular medical conditions? (N Tab 3: MedCon & Disability)

 No  Yes (please provide details below)

Medical conditions:

 Anaphylaxis (AN)  Diabetes (DB)  Asthma (AS)  Epilepsy (EP)

 Food allergies (FA) (please describe)

Other medical conditions: (OT) (please describe)

Have you worked with children who have particular disabilities or special needs? (DS)

 No  Yes (please provide details below)

Have you cared for twins, triplets or other multiple siblings? (Keyword: twins/triplets))

 No  Yes (please provide details below)

Do you have children
of your own?  No
(N Tab 3)
 Yes (please provide their names and dates of birth)

If yes, will you need to bring them with you on assignment?

 Not essential
 Preferred
 Yes - essential (which of your children will accompany you?)

Name Date of Birth Age

How far are you willing to travel to assignments/work? (N Tab 3 – Trael Time Pref.)

 Up to 30 mins from my residence

 Greater Brisbane – up to 1 hour each way
 As far as required
 Gold Coast
 Sunshine Coast

Other comments / preferences:

Work References
We have a preference to work with child care workers who can provide three references (excluding
family members). If possible, two references should be from the child care industry. If this is not
possible, then provide your best three references.

Please complete this section fully – do not write “Refer to resume”

N Tab 2: # Refs Supplied
Can you provide us with references from previous employers?

 Yes – written references are included with resume and noted below
 Yes – phone numbers for verbal references are listed below (MANDATORY)
 No verbal or written references are available at this time
PLEASE DO NOT USE FAMILY MEMBERS AS REFEREES
ONE REFEREE MUST BE RELATED TO HAVING WORKED WITH AN INFANT
Reference 1:
Name

How do you know

this person?
Address

Phone

How long have you

known this person?

Reference 2:
Name

How do you know

this person?
Address

Phone

How long have you

known this person?

Reference 3:
Name

How do you know

this person?
Address

Phone

How long have you

known this person?
Applicant’s Declaration
I, ______________________________________________ hereby declare all information on this
application form is true and correct. I understand that any misleading information may be harmful
to my employer’s children, for which I will be held fully accountable. I acknowledge that Centenary
Nannies and Babysitters takes no responsibility for any harm to my employer or myself.

Signed: ________________________________________ Date: _______________________

Applicant Check List

Please take a moment to review your application to ensure ALL questions have been answered, to
give you the best opportunity to be chosen for work with our clients.

We require the following to accompany your application:

 Resume

 Cover letter to families

 References (if not included in resume)

 Copies of Certificates Attained

 Copy of Blue Card (mandatory)

 Copy of First Aid Certificate (if applicable)

 Copy of driver’s licence (mandatory)

 Copy of your Medicare Card (mandatory: For ID purposes)

 Provide us with a photograph of yourself (if you do not have a drivers licence) Hard copy
or electronic file by email).

Please note our guarantee that we will never send your photograph to any
other person or organisation without your permission. We store your
photograph with your resume and other documents to help us “put a face to
the name”.

 Copy of your current vehicle insurance policy

 Sign and date the application