Family Day Care Registration and Membership Form

Section 1 – Personal and Family Details

Have you lived/worked outside of Australia within the past three years?
Current accommodation type
If rental, has owner given permission for you to provide an FDC service?
Has the landlord given permissions for any modifications to the home for FDC?
Do you have any pet(s)?
Do you give permission for your occupant(s) to contact Communicare Family Day Care Service, on matters with regards to your business operations?
Do any of the occupants smoke?

Section 2 - Current/Previous Employment History

Academic Achievements and Qualifications

Family Day Care Licence/Registration

Have you ever held a Family Day Care Licence?
Do you have a current FDC registration?
Have you been denied, revoked or suspended of any FDC licence/registration?
Have you been issued a prohibition notice by the Education and Care Regulatory Unit (ECRU) before?

Section 3 - Questionnaire for Applicant

Do you know any educators currently with Communicare Family Day Care Services?
Are you able to (tick all boxes if applicable)




 
Declaration by Applicant
  1. The information provided in this form (including any attachments) is true, complete and correct;
  2. I acknowledge that, in considering this application, the Service is relying on the truth, completeness and correctness of that information and has the right to revoke my registration in the event that any of the information proves to be untrue, incomplete or incorrect;
  3. I have read and understood and I agree to the conditions and the associated material contained in this form;
  4. I understand that the Regulatory Authority and/or Australian Children’s Education and Care Quality Authority (ACECQA) will have the right (but will not be obliged) to act in reliance upon the contents of this form, including its attachments;
  5. I have read and understood my legal obligations under the Education and Care Services National Law;
  6. Some of the information provided in this form may be disclosed to Commonwealth for the purposes of the Family Assistance Law and may be disclosed to other persons/authorities where authorised by the Education and Care Services National Law or other legislation;
  7. I am aware that I may be subject to penalties under the Education and Care Services National Law if I provide false or misleading information in this form and
  8. I am aware that if I provide false or misleading information at application, this application will be void and my termination will be reported in the FDCWA educators’ list which is made available to all FDCWA members;
  9. I acknowledge that this application is only valid for six (6) months from the time of Interview One. Communicare FDC Service can cease to register the applicant if the processes do not meet satisfactory requirements or time period of 6 months.
  10. ‚ÄčThere will be no refund of the application fee unless otherwise agreed upon.

The Inclusion Support Programme is funded by the Australian Government Department of Education and Training.