Carer Update

Personal Details

First Name*
Please enter your first name.
Last Name*
Please enter your last name.
Email*
Please enter your email.
Carer Type*
  • - select an option -
  • Child Carer
  • Cleaner
  • Both
Please answer the question.
Mobile Phone*
Please enter your mobile phone.
Home Phone
Field is required!
Street Address*
Please enter your street address.
Suburb*
Please enter your suburb.
Postcode*
Please enter your postcode.
State*
  • - select an option -
  • Victoria
  • Queensland
  • New South Wales
  • Australian Capital Territory
  • Tasmania
  • South Australia
  • Western Australia
  • Northern Territory
Please enter your state.
Please tell us about any new skills or experiences that you would like to have listed on your profile
Field is required!

Medical Declaration

Have you ever had a Worker's Compensation Claim?*
Please answer the question.
If yes, Details of Worker's Compensation Claim*
If no, enter N/A
Please enter details.
Please select any of the following that apply to you
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
List Allergies
Field is required!

Do you have any of the following medical conditions?

Mental Illness*
Please answer the question.
If yes, Specify which mental health condition you have along with the nature on how this medical condition impacts you*
If no, enter N/A
Please enter details.
Diabetes*
Please answer the question.
If yes, Specify the nature of how diabetes impacts you*
If no, enter N/A
Please enter details.
Asthma*
Please answer the question.
If yes, Specify the nature of how asthma impacts you*
If no, enter N/A
Please enter details.
Epilepsy*
Please answer the question.
If yes, Specify the nature of how epilepsy impacts you*
If no, enter N/A
Please enter details.
Heart Disease*
Please answer the question.
If yes, Specify the nature of how heart disease impacts you*
If no, enter N/A
Please enter details.
Back Problems*
Please answer the question.
If yes, Specify the nature of how back problems impacts you*
If no, enter N/A
Please enter details.
Other Existing Medical Conditions*
Existing is a medical condition for which treatment is still being received
Please answer the question.
If yes, Specify the nature of how these existing medical condition(s) impact you*
If no, enter N/A
Please enter details.
Other Pre-existing Medical Conditions*
Pre-existing is where an injury or medical condition/s is present, but treatment is not required
Please answer the question.
If yes, Specify the nature of how these pre-existing medical condition(s) impact you*
If no, enter N/A
Please enter details.
Do you take medication for any of the above ticked medical conditions?*
Please answer the question.
If yes, Specify and side effects or treatment plans an employer needs to be made aware of*
If no, enter N/A
Please enter details.
Date
Field is required!
I declare that each and every answer above is true to the best of my knowledge and belief*
I understand that any false or misleading information may result in termination of employment. I understand that I may also be required to provide copies medical assessments/medical clearance/doctors/medical specialists letters during employment and on termination.
Please confirm.

Long Term Availability

Please indicate your long term availability

PLEASE READ THE BELOW VERY CAREFULLY - BEFORE TICKING the relevant time slots below

TICK = means you are ALREADY working for an AGENCY client

TICK = means you would like to be offered permanent or short term work opportunities

TICK = means you are available to be approached about work but can decline our offers if they do not suit

TICK = do NOT leave time slot BLANK if you are ALREADY working for an AGENCY client or WOULD consider work

(If you don't put a TICK then you will NEVER hear from the AGENCY regarding work at that time)

IT IS BETTER TO PUT A TICK AS YOU CAN ALWAYS DECLINE OUR OFFERS

BLANK = means you work for a NON AGENCY related client or job regularly and cannot represent the Agency ever

BLANK = means you are engaged in regular recreational activities and NEVER want to be offered work at that time

BLANK = means that you never ever EVER want to work at that time

(If you leave a time slot BLANK then you will NEVER hear from us regarding work at that time)

IT'S REALLY IMPORTANT TO GET THIS RIGHT

We are here to help - please give us a call on (03) 9576 7000 if you are unsure of what days to tick.
Monday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Tuesday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Wednesday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Thursday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Friday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Saturday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!
Sunday
Field is required!
Field is required!
Field is required!
Field is required!
Field is required!

Confirmation

Have any of the AGENCY CLIENTS that you work for told you that they NEVER require you again due to COVID-19? If Yes, please describe*
If no, enter N/A
Please answer the question.
Would you like us to actively be providing job/interview opportunities to you? If yes, please describe what you are looking for*
If no, enter N/A
Please answer the question.
I confirm that all information provided is accurate and current, and I give my consent to Melbourne's Leading Nanny Agency to contact my references.*
Please confirm.